{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T13:52:53Z","timestamp":1753883573136,"version":"3.41.2"},"reference-count":15,"publisher":"The Endocrine Society","issue":"1","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>As the leading cause of hyperthyroidism, Graves disease (GD) does not often present with its classical triad of pretibial myxedema, goiter, and exophthalmos but instead is often recognized by various manifestations such as tachycardia, weight loss, jaundice, or dermatopathy and requires utmost clinical vigilance. Three treatment modalities for GD exist as antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery, but each bears its own serious side effects. Furthermore, there have been several reports in the literature about ATD resistance that can complicate management. We describe a rare complex case of methimazole (MMI)-resistant GD in a 58-year-old woman with multiple comorbidities including heart failure, atrial fibrillation, liver cirrhosis, and hypertension. She presented with an initial complaint of diffuse swelling and was found to have severe thyrotoxicosis. Despite high doses of MMI, her thyroid function remained significantly elevated. Thyroid uptake and scan while on MMI showed high radioactive iodine uptake. After receiving RAI therapy, her thyroid function and bilirubin improved markedly, liver enzymes remained stable, and anasarca responded to diuretics. This case highlights the challenges in managing resistant GD and emphasizes the necessity of personalized treatment plans.<\/jats:p>","DOI":"10.1210\/jcemcr\/luae235","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T14:00:29Z","timestamp":1734616829000},"source":"Crossref","is-referenced-by-count":0,"title":["Unusual Management of a Rare Case of Methimazole-Resistant Graves Disease"],"prefix":"10.1210","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6242-7569","authenticated-orcid":false,"given":"Michael","family":"Tang","sequence":"first","affiliation":[{"name":"Baylor University Medical Center , Dallas, TX 75246 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7676-9447","authenticated-orcid":false,"given":"Bashar","family":"Fteiha","sequence":"additional","affiliation":[{"name":"Baylor University Medical Center , Dallas, TX 75246 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9601-384X","authenticated-orcid":false,"given":"Shumei","family":"Meng","sequence":"additional","affiliation":[{"name":"Baylor University Medical Center , Dallas, TX 75246 ,","place":["USA"]},{"name":"Texas A&M School of Medicine , Bryan, TX 77807 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"80","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"issue":"16","key":"2025011704222974900_luae235-B1","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1056\/NEJMra1510030","article-title":"Graves\u2019 disease","volume":"375","author":"Smith","year":"2016","journal-title":"N Engl J Med"},{"key":"2025011704222974900_luae235-B2","doi-asserted-by":"crossref","first-page":"768019","DOI":"10.1155\/2012\/768019","article-title":"Atypical clinical manifestations of graves\u2019 disease: an analysis in depth","volume":"2012","author":"Hegazi","year":"2012","journal-title":"J Thyroid Res"},{"issue":"12","key":"2025011704222974900_luae235-B3","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1038\/nrendo.2013.193","article-title":"Diagnosis and management of graves disease: a global overview","volume":"9","author":"Bartalena","year":"2013","journal-title":"Nat Rev Endocrinol"},{"issue":"11","key":"2025011704222974900_luae235-B4","doi-asserted-by":"crossref","first-page":"2956","DOI":"10.1210\/clinem\/dgae222","article-title":"A 2023 international survey of clinical practice patterns in the management of graves disease: a decade of change","volume":"109","author":"Villagelin","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2025011704222974900_luae235-B5","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.ecl.2021.12.004","article-title":"2022 update on clinical management of graves disease and thyroid eye 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