Case 7 THYROID DISEASE
History: A 35 year old nurse complained of nervousness, mood swings, weakness, and palpitations with exertion for the past 6 months. Recently, she noticed excessive sweating and wanted to sleep with fewer blankets than her husband. She used oral contraceptives and her menstrual periods were regular.
Physical examination: Pulse was 92/minute and BP was 130/60. She appeared anxious, with a smooth, warm, and moist skin, a fine tremor, a bounding cardiac apical impulse, and she couldn't rise from a deep knee bend without aid. Her thyroid was diffusely enlarged, soft, mobile, without nodularity and there was no lymphadenopathy. Her eyes were not prominent (proptotic) and she had no focal skin thickening.
Laboratory studies: Serum T4=15.6 ug/dl and serum T3=210 ng/dl.1. What is the level of thyroid function in this patient? Are additional diagnostic tests necessary to define the level of thyroid function and if so which one(s)? Answer
2. What is the most likely cause of this patient's illness? What tests are necessary to confirm its cause? Are antithyroid antibodies helpful? Answer
3. What are the treatment options? Answer