Doc750
transfer:step 3 prison
Topics: 52
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A 34 year old woman presents to your office complaining of a 2 month history of excessive sweating, palpitations, weight loss, and nervousness. On PE, she has a BP of 170/80 mm Hg and a HR of 130/min. She has a diffusely enlarged, nontender and smooth thyroid, as well as proptosis, lid lag, and exopthalmos. More over, you notice that the patient has nonpitting edema over the pretibial aspect of her legs. You suspect graves disease.
1) What lab test would confirm that the patient is suffering from hyperthyroidism?
2) What treatment should be instituted at this time?
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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| neurom
Forum Senior
Topics: 2
Posts: 127
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high T3, T4, low TSH.
treatment - PTU, when she becomes euthyroid - radioactive iodine, then hormone replacement therapy.
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| tamerbashir
Forum Elite
Topics: 20
Posts: 284
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T4 high , low TSH , +VE TSI IN GRAVES
TREATEMENT ; PTU IF FAIL RADIO I AFTER -VE PREGNANCY TEST &H.R AFTER
PREDNISONE FOR OPHALMOPATHY PROPRANOL FOR TACHY&RESTLESSNSS
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| cool doctor
Forum Junior
Topics: 1
Posts: 226
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as neurom said
but its not necessary that you will need HRT after iodine therapy.
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| Doc750
transfer:step 3 prison
Topics: 52
Posts: 636
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1) Elevated serum T4 would confirm the diagnosis for hyperthyroidism
to further differentiate b/w the potential causes of hyperthyroidism, a radioactive iodine uptake could be done. The I-131 uptake is extremely elevated in Graves Disease and is moderately elevated in toxic nodular goiter. By contrast, the uptake of I-131 is low in autoimmune thyroiditis, subacute thyroiditis, and factitious hyperthyroidism.
2) Tx BB with PTU or methimazole
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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| me007
Forum Guru
Topics: 72
Posts: 803
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if exophtalmos present - oral prednisone the must
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| Vietnamese
Forum Elite
Topics: 12
Posts: 285
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1- Free T4, T3 increased, low TSH ( Primary Hyperthyroidism). Note that secondary hyperthyroidism have increase both for TSH and T4,T3.
2-PTU, Propanolol first, if failed then Iode-radio or thyroidectomy
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