: A 50-year-old woman presents with an anterior neck enlargement. She reports in

Question

: A 50-year-old woman presents with an anterior neck enlargement. She reports increased appetite, weight loss, and frequent bowel movements over the past month. She is 5'8" tall & weighs 150 lb. Resting heart rate is 84 BPM, & BP is 112/78 mm Hg. She seems to “stare,” & her eyelids close incompletely. Palpation reveals that the thyroid gland is enlarged. It weighs an estimated 40g (normal = 15-20g).

The test results for this patient were as follows (S = measured in serum):

Patient's value Normal range
Calcium, total (S) 10.2 mg/dl 8.4 - 10.2
Phosphorus 4.6 mg/dl 2.7 - 4.5
Alkaline phosphatase (S) 130 U/L 49 - 120
T4, Total (S) 12.2 ug/dl 5 - 11.5
T3, Total (S) 311 ng/dl 100 - 215
TSH (S) <0.1 uU/ml 0.7 -7.0
Free thyroxine index (FTI) 14.6 6 - 11.5

Uptake of radioactive iodine into the thyroid gland showed 68% uptake at 6 hr with radioactive iodine (normal is 5% - 28% uptake).
Serum was obtained for anti-thyroid antibody tests:
Patient Normal
Antithyroglobulin Ab. neg. neg.
Antimicrosomal Ab. pos. neg.

What is your diagnosis? Provide evidence (signs and symptoms) to support your answer completely.




How should this patient be treated?

Explanation / Answer

The diagnosis is hypothyroidism. The inflammed throat shows goitre which is a sign of hypothyroidism. The low FTI and low T4 levels are also a characteristic of hypothyroidism. The high TSH level is also a characteristic of hypothyroidism Cholesterol levels are also expected to be high in hypothyroidism ---------------------------------------- Hypothyroidism is treated with a mixture of levo-rotatory forms of T3 and T4. The diagnosis is hypothyroidism. The inflammed throat shows goitre which is a sign of hypothyroidism. The low FTI and low T4 levels are also a characteristic of hypothyroidism. The high TSH level is also a characteristic of hypothyroidism Cholesterol levels are also expected to be high in hypothyroidism ---------------------------------------- Hypothyroidism is treated with a mixture of levo-rotatory forms of T3 and T4.

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