Case 050: Thyroid Disorders

PATIENT PRESENTATION

Chief Complaint

Follow up for treatment of Graves disease

History of Present Illness

Follow-up management of methimazole and beta-blocker therapy for treatment of recently diagnosed Graves disease.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. Which signs and symptoms of Graves disease did this patient experience? Which signs and symptoms were assessed but this patient was negative for?

   Hint: See Hyperthyroidism and Thyrotoxicosis in PPP

2. What monitoring should be performed when a patient is receiving thioamide therapy? List from both the patient and healthcare team perspective.

   Hint: See Hyperthyroidism and Thyrotoxicosis in PPP

3. What complications can arise from inadequately treated hyperthyroidism?

   Hint: See Hyperthyroidism and Thyrotoxicosis in PPP

4. How does amiodarone induce hyperthyroidism? List additional medications that induce hyperthyroidism.

   Hint: See Drug-Induced Thyroid Abnormalities in PPP

5. What is ideal management of Graves’ disease during pregnancy?

   Hint: See Hyperthyroidism and Thyrotoxicosis in PPP

FOLLOW-UP

What are the potential next steps in the management of this patients Grave’s disease? What are the risks and benefits of each potential next step? What treatment options exist for Graves’ ophthalmopathy?

Hint: See Hyperthyroidism and Thyrotoxicosis in PPP

CASE SUMMARY

Global Perspective

Graves disease is the most common cause of hyperthyroidism in populations with iodine replete diets. Areas with iodine deficient diets have higher rates of nodular thyroid disease. Carbimazole is alternative thionamide therapy that is used outside of the United States. Preferred treatment of hyperthyroidism with anti-thyroid drugs, surgery, or radioactive iodine varies between countries.

Key References