Thyroid Hormone Resistance (THR) is a rare syndrome of reduced responsiveness of target tissues to thyroid hormone (TH). This article intends to review the classification, pathogenesis, clinical presentation, diagnosis and treatment of this rare entity.

This cross sectional, observational, non-interventional study has assessed the incidence of sexual dysfunction, and the effect of thyroxine replacement on sexual function in hypothyroid women. Female Sexual Function Index (FSFI) questionnaire was administered to 120 women with well-controlled hypothyroidism (serum TSH level 0.51 - 5.00, mean 3.36 ± 2.41 mU/L) and 30 with uncontrolled (serum TSH level 8.26 - 24.26, mean 12.20 ± 4.80 mU/L) hypothyroidism. Control consisted of 120 women with no obvious endocrinopathy. Uncontrolled subjects scored lower than controls in domains of desire (2.40 ± 0.88 vs. 3.80 ± 1.43; p<0.01), arousal (2.50 ± 1.70 vs. 4.07 ± 1.11; p<0.01), orgasm (2.90 ± 2.32 vs. 5.30 ± 0.68; p<0.01), satisfaction (4.50 ± 2.28 vs. 5.80 ± 0.60; p<0.05) and total score (30.66 ± 29.34 vs. 76.60 ± 10.10, p<0.001). Well- controlled patients scored less than controls in all domains, with significant difference in orgasm (4.50 ± 0.87 vs. 5.30 ± 0.68; p<0.05) and total score (58.30 ± 26.56 vs. 76.60 ± 10.10; p<0.05). Well-controlled subjects scored higher than uncontrolled subjects only in lubrication (4.70 ± 0.63 vs. 2.40 ± 2.14; p<0.001), orgasm (4.50 ± 0.87 vs. 2.90 ± 2.32; p<0.05) and total score (58.30 ± 26.56 vs. 30.66 ± 29.34; p<0.05). There was no correlation of FSFI scores with age, duration of hypothyroidism, years of marriage or TSH levels. This study highlights the prevalence of sexual dysfunction in hypothyroid women. This dysfunction, especially orgasm disorder, persists after optimal thyroxine supplementation.

Thyrotoxic periodic paralysis (TPP) is a rare complication of thyrotoxicosis. Common precipitating factors include high carbohydrate diet, alcohol ingestion, strenuous exercise followed by rest, emotional stress, and treatment with insulin or acetazolamide. There are not much reports of steroid treatment precipitating TPP. In this particular patient TPP was manifested after treatment with long acting methyl prednisolone for symptomatic Graves' ophthalmopathy. Diagnosis was made after ECG and laboratory confirmation of hypokalemia and was treated with potassium supplementation upon which he showed full recovery. This case is reported for the awareness about the possibility of precipitation of TPP while treating Graves' ophthalmopathy with high dose steroid pulse therapy.

Acute thyroid storm is a disease state that results from thyroid hormone induced hyper-metabolism. The excess thyroid hormone is released from the thyroid gland as a result of excess thyroid production, or by processes that disrupt the follicular structure of the gland with subsequent release of stored hormone. Thyroid storm may lead to irreversible cardio vascular collapse and death if proper treatment is not initiated immediately. We had seen 7 cases of acute thyroid crisis in various medical emergencies both causing the medical emergencies and as well as aggravating the existing medical illness. All the patients had the classical features of tachycardia, delirium, altered sensorium and hyper dynamic cardiac failure. Three patients had acute atrial fibrillation causing CCF and stroke; one had post partum supraventricular tachycardia; three cases had pneumonia with ARDS. All had strenuous in-hospital course not responding to conventional treatment and responded dramatically to anti-thyroid drugs and iodine. There was a delay in suspecting and instituting the proper treatment. One must suspect acute thyroid crisis in all cases of unexplained coma, medical conditions not responding to treatment like CVA, acute pulmonary edema, atrial fibrillation and thromboembolism, ARDS and MOSF, seizures and myoclonus, post irradiation and supra ventricular tachycardia.