- 35 y.o female secretary (brought in crying after a fight with her boyfriend, accuse him of hitting her)
- Fast & loud heartbeat
- Often anxious, nervous and unable to concentrate on her work (symptoms worsening)
- Could not tolerate hot temperature
- BP: 150/80 mmHg
- Pulse regular, pulse rate: 100 per minute
- Skin is warm & moist, sweaty palms & fine tremors
- Large starring eyes
- full bood count: no anaemia
- Normal liver function tests
- TSH level decreased, free T4 is increased
- Thyroid antibody test positive, TSI/LATS (autoimmune)
- Thyroid scan: diffusely enlarged gland with increased uptake of radioactivity
Why do we perform a liver function test?
To monitor liver toxicity caused by thioamides (an antithyroid medication)
What is the expected blood picture for a patient with hyperthyroidism?
- normocytic anemia (maybe)
- decreased white blood cell
- decreased platelet
What other investigations we can do?
- increased sex hormone-binding globulin levels, decreased free testosterone level
- Diabetes (haemoglobin A1C)
- Fasting lipid profile (decreased total cholesterol level)
- High titre serum antibodies to collagen X11 (associated with active Graves’ ophthalmology)
What is the implication if a pregnant patient is suffering from maternal Graves’ disease?
Neonatal toxicosis of the infant