Refractory hypothyroidism (RF) defined as raised serum levels of thyroid stimulating hormone (TSH) above upper limit of the reference range with or without the persistence of hypothyroid symptoms following a 6-week interval after the dosage was last increased to upper limits of dose per age. The most common cause of RH is inadequate compliance. In addition, diet, concomitant medication interactions, and gastrointestinal diseases can all result in l-thyroxine (LT4) malabsorption, which can cause RH. Moreover, weight gain, switching brands of LT4, poor storage of LT4, chronic liver disorders, cystic fibrosis, nephrotic syndrome, consumptive hypothyroidism, Addison’s disease are significant contributors to RF in children. RH in children is frequently asymptomatic, when symptoms do occur, they are typically minor and resemble those of hypothyroidism. It is essential to identify RH early and treat its underlying cause

Background: Meniere's disease is a chronic illness that produces a triad of symptoms; vertigo, hearing loss and tinnitus, each of which is known to have the potential to impact on quality of life and patients' self-care. Aim: Evaluate the effect of life style and dietary intervention on quality of life and self-care among patients with Meniere's disease. Patients and Method: A quasi-experimental (pre-posttest nonequivalent control group design) was used for a purposive sample of sixty adult patients, diagnosed with Meniere's disease in the Ear, Nose and Throat (ENT) department and outpatient clinics at Assiut University Hospital. Patients were randomly divided into two equal groups (study and control) 30 patients for each. Tools: Tool (I): Demographic and medical background information form, Tool (II): Dizziness Handicap Inventory and Tool (III): Therapeutic self-care measure. Results: The mean age of the study and control groups was (44±9.8, 42.03±10.3) years respectively. There was a statistically significant difference between study and control groups regarding the total QoL scores (60.13±14.55, 57.33±13.58), (35.33±7.62, 47.87±17.62) respectively, pre and post lifestyle and dietary intervention with p. value <0.001**. Also, there was a significant improvement in total mean scores of self –care measure among study group as it increased from 20.1±5.52 on pre-intervention to 42.13±8.52 post. Conclusion: Life style and dietary intervention had a positive effect on improving quality of life and self-care activities among study group patients at 3- month follow up compared to the control group. Recommendations: Healthy lifestyle and dietary modifications should be considered as an initial step for both the prevention and management of Meniere's disease.