Thyroid Case Study ESR [019] &[020] Flashcards
- A 20-year old lady presented to her GP with difficulties in sleeping. She had
been very irritable for the last 6 months, and had had palpitations, weight loss and
sweating over the past year. She had noticed a swelling in her own neck over the past
year.
On examination she had a fine tremor and looked thin. Her pulse was 105 beats per
minute and her blood pressure 110/75 mm Hg. She had a neck swelling which moved
with swallowing. It was soft, was symmetrical and was not tender to touch. Her GP sent
a blood sample to the hospital for thyroid tests.
Case 2. A 57-year old woman presented to her GP with progressive tiredness. She
wanted a vitamin injection to give her more energy. She had stopped working as a
sales clerk in her local shop 6 months earlier because she had felt tired and unable to
continue working. On further questioning, she admitted to being constipated, intolerant
of the cold and half a stone heavier than previously. Her periods were now heavier and
lasted longer than before. There was no other illness in her family.
On examination she was pale, was overweight and appeared disinterested. Her pulse
was 55 beats per minute, and her blood pressure 105/75 mm Hg. She had slow
relaxing reflexes. Her GP sent a blood sample to the hospital for thyroid tests.
- A 20-year old lady presented to her GP with difficulties in sleeping. She had
been very irritable for the last 6 months, and had had palpitations, weight loss and
sweating over the past year. She had noticed a swelling in her own neck over the past
year.
On examination she had a fine tremor and looked thin. Her pulse was 105 beats per
minute and her blood pressure 110/75 mm Hg. She had a neck swelling which moved
with swallowing. It was soft, was symmetrical and was not tender to touch. Her GP sent
a blood sample to the hospital for thyroid tests.
Case 2. A 57-year old woman presented to her GP with progressive tiredness. She
wanted a vitamin injection to give her more energy. She had stopped working as a
sales clerk in her local shop 6 months earlier because she had felt tired and unable to
continue working. On further questioning, she admitted to being constipated, intolerant
of the cold and half a stone heavier than previously. Her periods were now heavier and
lasted longer than before. There was no other illness in her family.
On examination she was pale, was overweight and appeared disinterested. Her pulse
was 55 beats per minute, and her blood pressure 105/75 mm Hg. She had slow
relaxing reflexes. Her GP sent a blood sample to the hospital for thyroid tests.
- A 20-year old lady presented to her GP with difficulties in sleeping. She had
been very irritable for the last 6 months, and had had palpitations, weight loss and
sweating over the past year. She had noticed a swelling in her own neck over the past
year.
On examination she had a fine tremor and looked thin. Her pulse was 105 beats per
minute and her blood pressure 110/75 mm Hg. She had a neck swelling which moved
with swallowing. It was soft, was symmetrical and was not tender to touch. Her GP sent
a blood sample to the hospital for thyroid tests.
Case 2. A 57-year old woman presented to her GP with progressive tiredness. She
wanted a vitamin injection to give her more energy. She had stopped working as a
sales clerk in her local shop 6 months earlier because she had felt tired and unable to
continue working. On further questioning, she admitted to being constipated, intolerant
of the cold and half a stone heavier than previously. Her periods were now heavier and
lasted longer than before. There was no other illness in her family.
On examination she was pale, was overweight and appeared disinterested. Her pulse
was 55 beats per minute, and her blood pressure 105/75 mm Hg. She had slow
relaxing reflexes. Her GP sent a blood sample to the hospital for thyroid tests.
- A 20-year old lady presented to her GP with difficulties in sleeping. She had
been very irritable for the last 6 months, and had had palpitations, weight loss and
sweating over the past year. She had noticed a swelling in her own neck over the past
year.
On examination she had a fine tremor and looked thin. Her pulse was 105 beats per
minute and her blood pressure 110/75 mm Hg. She had a neck swelling which moved
with swallowing. It was soft, was symmetrical and was not tender to touch. Her GP sent
a blood sample to the hospital for thyroid tests.
Case 2. A 57-year old woman presented to her GP with progressive tiredness. She
wanted a vitamin injection to give her more energy. She had stopped working as a
sales clerk in her local shop 6 months earlier because she had felt tired and unable to
continue working. On further questioning, she admitted to being constipated, intolerant
of the cold and half a stone heavier than previously. Her periods were now heavier and
lasted longer than before. There was no other illness in her family.
On examination she was pale, was overweight and appeared disinterested. Her pulse
was 55 beats per minute, and her blood pressure 105/75 mm Hg. She had slow
relaxing reflexes. Her GP sent a blood sample to the hospital for thyroid tests.
A 35-year-old part-time nurse presents to her GP with a 6-month history of weight loss of 10kg. On questioning she was eating well but complained of diarrhoea. She had also noticed that she felt exhausted and had developed insomnia. On further questioning she admitted to feeling increasingly hot and shaky and to having muscle weakness of the legs, particularly climbing stairs. She was normally well and had not seen the doctor since her last pregnancy 8 years before. A blood test revealed the following results: free T4 49.7pmol/L; total T4 225 nmol/L; TSH <0.01mU/L. She was referred to an endocrinologist at the local hospital where investigations confirmed her diagnosis.
- What would be the most likely diagnosis of her condition?
Hyperthyroidism - Graves disease accounts for 75% of cases, it is the most common cause of overactive thyroid gland (hyperthyroidism). It is caused by an autoantibody (called thyroid stimulating immunoglobulin, TSI) that acts like thyroid-stimulating hormone (TSH) and that causes the thyroid gland to produce excess thyroid hormone. Those most likely to have the disease are women over 20 years of age. According to the National Women’s Health Information Center, Graves’ disease affects about 2% of women at some time in their lives. Graves’ disease may cause symptoms and signs such as weight loss, increased appetite, hand tremors, heat sensitivity, sweating, nervousness, and in some patients, protruding eyes. Patients with the disease often have an increased heart rate and an enlarged but not painful thyroid gland (goiter).
A 35-year-old part-time nurse presents to her GP with a 6-month history of weight loss of 10kg. On questioning she was eating well but complained of diarrhoea. She had also noticed that she felt exhausted and had developed insomnia. On further questioning she admitted to feeling increasingly hot and shaky and to having muscle weakness of the legs, particularly climbing stairs. She was normally well and had not seen the doctor since her last pregnancy 8 years before. A blood test revealed the following results: free T4 49.7pmol/L; total T4 225 nmol/L; TSH <0.01mU/L. She was referred to an endocrinologist at the local hospital where investigations confirmed her diagnosis.
- What treatments would you recommend?
Initially carbimazole and propanolol, for one month then withdraw the propanolol. Longer term 131 I ablation can be considered.
After therapy she became euthyroid and we seen at 6 monthily intervals at the latest visit she complained of lethargy, weight gain and feeling cold all the time. A blood test showed the following results: free T4 4.5pmol/L; TSH 25.7mU/L.
A 35-year-old part-time nurse presents to her GP with a 6-month history of weight loss of 10kg. On questioning she was eating well but complained of diarrhoea. She had also noticed that she felt exhausted and had developed insomnia. On further questioning she admitted to feeling increasingly hot and shaky and to having muscle weakness of the legs, particularly climbing stairs. She was normally well and had not seen the doctor since her last pregnancy 8 years before. A blood test revealed the following results: free T4 49.7pmol/L; total T4 225 nmol/L; TSH <0.01mU/L. She was referred to an endocrinologist at the local hospital where investigations confirmed her diagnosis.
- What treatment is now required for this patient?
She now has symptoms of hypothyroidism presuamably due to the 131 I ablation she opted , so she now requires T4 replacement, which should resolve her present symptoms in a few months.
