Dr Charles White

Thyroid Specialist

Bayview Private Hospital

81 Canyon Road

Bayview

01/06/2014

Dear Dr White ,

Re: Ms Lola Duval DOB: 27/05/1990

I am writing to refer Ms Duval, a 31-year-old student , who has been recently diagnosed with
hyperthyroidism which is probably due to Grave’s disease. Your early assessment and management
would be acknowledged.

Regarding Ms Duval’s history, she has had anxiety and insomnia ,for which she has been taking sleeping
pills.

On the day before, Ms Duval reported that she had lost 10 Kgs over the previous 2 months in spite of
eating well and having a good appetite. Also, she disclosed having tremors, palpitations, sweating ,
fatigue and heat intolerance . On examination, her vitals were within normal ;however, tremors in her
hands and an enlarged non-tender thyroid gland were detected. Additionally, eye movement test
revealed exophthalmos and lid lag. Therefore , thyroid functions and ECG were requested as
hyperthyroidism was suspected.

Today, the previously ordered ECG showed sinus tachycardia . In addition, the blood tests were in
normal ranges , apart from a low TSH and elevated T3 and T4 ,which have been suggestive of
hyperthyroidism due to Grave’s disease. Accordingly, thyroid anti-body tests and a thyroid scan were
requested.

In view of the above/consequently, I am referring Ms Duval to you for early assessment as she feels
anxious about her possible diagnosis of Grave’s disease. For any queries, please do not hesitate to
contact me.

Yours sincerely,

Doctor