A 43-year old female presented herself in the opd for having a painless swelling on her neck.

She
mentioned that for the past 2 months, she has been experiencing dryness on her eyes, weight loss, and
trembling hands. According to her, her mother had hyperthyroidism. Upon the physical examination of
the physician, he noticed that her eyelids are pulled back, her heart rate was increased. Blood tests reveal:
low TSH, elevated Free T4, free and total T3, Normal glucose, sodium, potassium and uric acid.

Questions:
1. What is the probable diagnosis?
Graves’ Disease, an autoimmune disease that is normally the common cause of hyperthyroidism.
2. What lead the physician to his diagnosis?
Grave’s disease’s primary clinical findings are usually increased Free T4, free and total T3, and decreased
TSH. Patients would also display increased heart rate, fatigue, pulled back eyelids, weight loss, goiter,
trembling hands, and more.
3. Aside from chemistry tests, what are other tests that can be used to diagnose her?
Laboratory tests used to help diagnose Graves disease and distinguish it from other autoimmune
conditions may include one or more of the following. These tests detect the presence of thyroid
antibodies:
Thyroid stimulating immunoglobulin (TSI) — presence of this antibody is diagnostic for Graves disease
Thyroid stimulating hormone receptor antibody (TRAb) — less specific than TSI
Anti-thyroid peroxidase antibody (anti-TPO) — this autoantibody is found in most people with Graves
disease as well as in Hashimoto thyroiditis
Non laboratory tests:
Radioactive iodine uptake test. This test measures the amount of iodine the thyroid collects from the
bloodstream. If your thyroid collects large amounts of iodine, you may have Graves’ disease.
Thyroid scan. This scan shows how and where iodine is distributed in the thyroid. With Graves’ disease,
the entire thyroid is involved, so the iodine shows up throughout the gland. With other causes of
hyperthyroidism such as nodules—small lumps in the gland—the iodine shows up in a different pattern.
4. What is the treatment for her condition.
Removal of thyroid gland,
Beta blockers. Beta blockers don’t stop your thyroid from producing thyroid hormone but can reduce
symptoms until other treatments take effect. These medicines act quickly to relieve many of the
symptoms of hyperthyroidism, such as trembling, rapid heartbeat, and nervousness. Most people feel
better within hours of taking beta blockers.
Antithyroid medicines. Antithyroid therapy is the simplest way to treat hyperthyroidism. Antithyroid
medicines cause your thyroid to make less thyroid hormone. These medicines usually don’t provide a
permanent cure, but in some people, the effects last a long time after they stop taking the medicine.
radioiodine therapy, you take radioactive iodine-131 (I-131) by mouth as a capsule or liquid. I-131, at a
higher dose than the dose used for imaging tests, slowly destroys the cells of the thyroid gland that
produce thyroid hormone. The dose of I-131 usually used for radioiodine therapy does not affect other
body tissues.
You take radioactive iodine-131 as a capsule or liquid.
Although it’s unlikely, you may need more than one radioiodine treatment to bring your thyroid hormone
levels into the normal range.
5. If untreated, what are the side effects of his condition long term?
Without treatment, Graves’ disease can cause some serious health problems, including

an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related problems
an eye disease called Graves’ ophthalmopathy or Graves’ orbitopathy (GO), which can cause double
vision, light sensitivity, and eye pain—and, rarely, can lead to vision loss
thinning bones and osteoporosis