Introduction:
To restore normal thyroid hormone levels in hypothyroidism, oral levothyroxine sodium (LT4) continues to be the cornerstone of treatment. Levothyroxine absorption can be affected by age, patient compliance, fasting, and the consumption of certain foods or medications (1)(2). Refractory hypothyroidism can have numerous causes, including poor or non-adherence to levothyroxine daily doses, deiodinase deficiency, and various malabsorption disorders. Here we present a case of a 27-year-old female patient with refractory hypothyroidism with no response to oral levothyroxine that was managed with intravenous (IV) levothyroxine.