Natasha Romanick is a 19-year old aspiring model who has always dieted to keep h

Question

Natasha Romanick is a 19-year old aspiring model who has always dieted to keep her weight in an "acceptable" range. However, within the past 3 months, she has lost 20 pounds despite a voracious appetite. She complains of nervousness, sleeplessness, heart palpitations, and irregular menstrual periods. She notes that she is "always hot" and wants the thermostat set lower than her apartment mates. On physical examination, Natasha was restless and had a noticeable tremor in her hands. At 5 feet 8 inches tall, she weighed only 110 pounds. Her arterial blood pressure was 160/85, and her heart rate was 110 beats/minute. She was restless, and constantly on the move. Her questions were constant, repetitive, and a little strange. Based on her symptoms, the physician suspected that Natasha had thyrotoxicosis, or hyperthyroidism. However, it was unclear from the available information why her thyroid hormone levels were elevated. Laboratory tests were performed to determine the etiology of her condition. (Table below) Total T4Increased Free T4Increased TSH Undetectable (decreased

Explanation / Answer

Ans) Hyperthyroidism and Thyrotoxicosis

Hyperthyroidism is a condition in which there is hypersecretion or oversecretion of Thyroid hormones that causes certain set of disorders in the body functioning as these thyroid hormones are responsible for certain body's metabolic processess like controling temperature ,hunger also with growth hormones they regulate bone development and bone growth.

Thyrotoxicosis as the name implies is toxicity of thyroid hormones in circulating blood which results into hyperthyroidism hence thyrotoxicosis is a cause of hyperthyroidism. Both of the terms are sometimes used simultaneously as they are connected to each other. Thyrotoxicosis is life threatening condition, on other hand hyperthyroidism is not life threatening condition , but it if not treated properly may lead to worsen symptoms causing thyrotoxicosis.

With the symptoms of Natasha it could be noticed that the clinical features of hyperthyroidism like loosing weight , continuously hungry , restlessness , weakness. Also the symptoms getting worse with Increased heart rate, Heart palpitations which are some life threatening conditions and is therefore getting monitoring done. Tests including T3 T4 and TSH levels along with some other tests can improve the diagonosis , but the treatment plan is to be started to immediately settle down the lifethreatening conditions.

INITIAL MANAGEMENT - The initial management should be started to getting down the higher levels of thyroid hormones which is done by use of Beta blocking agent , these beta blocking agent causes blocking of effects of excess thyroid hormones peripherally , which is a long term treatment and continues up till the disease is controlled. Most common beta blocking agent is Propranolol.

Antithyroid Drug Treatment- Alongwith the beta blocking agents Antithyroid drugs are also started , which helps in blocking the synthesis of thyroid hormones. This Antythyroid drug therapy is a Long term control in children and adolescents. The dosage of antithyroid drug is managed every four weeks according to the symptoms relieved and tests done.Methimazole drug is most commonly used.

Radioactive Iodine therapy- This is the most effective treatment for hyperthyroidism , but with a caution it is used by checking whether the eye disease graves eye disease is present in natasha or not. Radioactive Iodine is usually administered in form of liquid or capsule alongwith antithyroid drug therapy.

If condition comes out to be severe Thyrotoxicosis and symptoms which are life treatening needs to be controlled faster hence Thyroidectomy is performed.

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