Skip to Main Content

++

INTRODUCTION

++

CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of subclinical and overt hyperthyroidism

  • Identify the goals of treatment for hyperthyroidism

  • Develop an appropriate pharmacotherapy care plan for the management of hyperthyroidism based on individual patient characteristics and appropriate clinical judgment

  • Properly educate a patient being treated for hyperthyroidism

++

PATIENT PRESENTATION

++

Chief Complaint

++

"My neck is swollen and I am having a hard time swallowing!"

++

History of Present Illness

++

Michael Vera is a 60-year-old female who presents to the clinic complaining of swelling and tenderness in her neck with difficulties swallowing solids and liquids, as well as 5 days of watery diarrhea. She appears anxious and is having a hard time sitting still during the interview. She explains that she has not felt like herself in well over a year, but things have gotten significantly worse over the last 4 months. She has had an unintentional weight loss of approximately 70 lb (32 kg) over the past year despite an increase in appetite. She attributes this weight loss to be the reason she is so exhausted and why her muscles have felt so weak of late. She also complains that she is heat intolerant and perspires with very little activity. Finally, she inquires about allergy eye drops as her eyes have been bothering her for the last several months since they are so itchy and watery, "feeling as if they are ready to pop out of my head."

++

Past Medical History

++

Seasonal allergies

++

Systolic hypertension × 1 year

++

Atrial fibrillation × 6 months

++

s/p total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) at age 45

++

Family History

++

Maternal grandmother with goiter and subsequent thyroidectomy. Mother with hyperthyroidism (treated with medication) and osteoporosis. Father with coronary artery disease and type 2 diabetes mellitus.

++

Social History

++

Married and lives with her husband of 37 years; has two dogs, and no children. She works as a kindergarten teacher at the local elementary school.

++

Tobacco/Alcohol/Substance Use

++

(+) Tobacco 45-pack year history (currently 1.5 ppd); (−) alcohol or illicit drug use.

++

Allergies/Intolerances/Adverse Drug Events

++

NKDA

++

Medications (Current)

++

Loratadine 10 mg PO daily PRN

++

Verapamil 240 mg PO daily

++

Digoxin 0.125 mg PO daily

++

Warfarin 2.5 mg PO daily

++

Calcium citrate with D (315 mg calcium with 200 IU Vitamin D3) two tablets PO three times daily

++

Review of Systems

++

Denies chest pain, shortness or breath, abdominal pain, hematochezia, dysuria, hematuria, changes in urinary frequency or urgency.

++

Physical Examination

...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.