Case Study: HYPERTHYROIDISM

K.B. is a 65-year-old man admitted to the hospital after a 5-day episode of “the flu” with
complaints of dyspnea on exertion, palpitations, chest pain, insomnia, and fatigue. K.B. was
diagnosed with Hyperthyroidism 6 months ago and placed on methimazole (Tapazole) 15
mg/day. His other past medical history includes heart failure and hypertension requiring
antihypertensive medications; however, he states that he has not been taking these
medications on a regular basis. Vital signs (VS) are: 150/90, 124 irregular, 20, 100.2 ° F (37.9 °
C). Admission assessment findings are: height 5 ft, 8 in; weight 132 lb; appears anxious and
restless; loud heart sounds; 1+ pitting edema noted in bilateral lower extremities; diminished
breath sounds with fine crackles in the posterior bases. K.B. begins to cry when he tells you he
recently lost his wife; you notice someone has punched several more holes in his belt so he could
tighten it.

Laboratory Values
Hemoglobin (Hgb) 11.8 g/dL
Hematocrit (Hct) 36%
Erythrocyte sedimentation rate (ESR) 48 mm/hr
Sodium 141 mmol/L
Potassium 4.7 mmol/L
Chloride 101 mmol/L
Blood urea nitrogen (BUN) 33 mg/dL
Creatinine 1.9 mg/dL
Free thyroxine (T4) 14.0 ng/dL
Triiodothyronine (T3) 230 ng/dL