Outcome and Follow-up
Based on the above mentioned findings, and after excluding any other potential cause, the patient was diagnosed with refractory hypothyroidism and was prescribed IV thyroxine 300 mcg three times weekly for the last four years. During the last follow-up visit, the patient was asymptomatic, showing no abnormalities, with a normal range of TSH (Figure 1) , t3, t4, and thyroglobulin (Figure 2) . Additionally, the patient is not complaining of any other medical conditions.