Stimulating discussion at Intern Report of a case of classic Grave’s hyperthyroidism. 21 yo F presenting with 40 lbs weight loss, palpitation, SOB\/DOE, neck swelling, diarrhea, irregular menses\u00a0for 6 months. On further evaluation was found to be hyperthyroid per labs and diagnosed with Grave’s disease (TSI\/ thyroid stimulating immunoglobulins-\u00a0elevated). She was also found to have an anterior mediastinal mass. She was started on beta blockers and methimazole and discharged with outpatient follow up appointments.<\/p>\n
Take home points:<\/p>\n
– when suspecting Grave’s hyperthyroidism, evaluate for ophthalmopathy as this can change management (requires pre treatment with steroids if considering radioiodine ablation)<\/p>\n
– as per guidelines TSI test is indicated for confirmation of Grave’s disease\u00a0only for; euthyroid patients with ophthalmopathy\u00a0and\u00a0pregnant patients. Otherwise TSI is not needed routinely\u00a0to confirm diagnosis<\/p>\n
– obilteration of retrosternal shadow could be anterior mediastinal mass or RV enlargement. In this patient is possibly thymic hyperplasia (paper stating association between Grave’s and thymic hyperplasia<\/a>)<\/p>\n – radioiodine ablation has low recurrence rates and lower cost (NEJM review paper on radioiodine for hyperthyroidism<\/a>)<\/p>\n