A Case of the Forgotten Thyroid: The Sequelae of Chronic Untreated Hypothyroidism

Hypothyroidism is a common endocrine disorder frequently caused by iodine deficiency, autoimmune disease, or as a result of certain medical treatments such as radioactive iodine. We report a 57-year-old woman 21 years pos-radioiodine ablation therapy for Graves' disease. She presented to the clinic after more than two decades without medical care with a variety of symptoms, including a left-sided lower facial droop and gait instability, and was found to have bradycardia, hyperlipidemia, and mild depression. After evaluation for vitamin deficiencies, anemia, thyroid dysfunction, and stroke, her symptoms were attributed to iatrogenic hypothyroidism. She was started on appropriate thyroid replacement therapy with subsequent symptom resolution. Patients receiving thyroid destructive therapy require education and close follow-up to prevent the development of severe hypothyroidism and its associated sequelae, which can be easily improved with simple, cost-effective thyroid replacement therapy.