Keywords:

  • 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

Hypothesis

Graves’ Disease

Learning issues:

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?

  • Gynecomastia
    • 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

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Terri is obsessed with making medical school as painless as possible. She studies and compiles medical school notes in a concise, easy-to-understand format. She also enjoys reading contributions by others. She is an investor in sustainability projects. Her ideal weekend is wine tasting and experimenting on bread-making. She has yet to master the art of Sourdough baking.

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