ENDO

BLOCK, PBL 2
A Girl with Eye Complains

An 18-year-old single female is evaluated for tachycardia, nervousness, heat intolerance,
weight loss, and irregular menses of 6 months duration. She takes no medication. She
also complains of a 1-week history of dry eyes that are sensitive to light and frequently
injected. She reports no blurred or double vision. She has frequent bowl movements.
Physical examination:
On physical examination blood pressure is 128/78 mm Hg, pulse rate is 124/min,
respiration rate is 16/min, and BMI is 19.5. Eyes examination revealed a slight lid
retraction and proptosis. Examination of the neck reveals a smooth enlarged thyroid
gland, no tenderness or bruit. There is a 3+ upper extremity tremor bilaterally. Reflexes
are brisk. Her family medical history revealed that her sister has a thyroid disease. She
was directed to the lab to take thyroid function test.
Investigations:
Thyroid-stimulating hormone (TSH) <0.01 µU/mL (0.01 mU/L) , Thyroxine (T4), free 5.5
ng/dL (71.0 pmol/L) , Triiodothyronine (T3), free 9.1 ng/L (14 pmol/L)
(Normal range (TSH) - 0.5-5.0 µU/mL (0.5-5.0 mU/L); Thyroxine (T4) 0.9-2.4 ng/dL (12-31
pmol/L), Triiodothyronine free (T3-3.6-5.6ng/L (5.6-8.6pmol/L).
Radioactive iodine uptake showed high uptake with a diffuse pattern after a thyroid
gamma probe scan.
Patient was diagnosed as a case of Graves disease. Her primary physician started her on
atenelol to control her tachycardia and predinslone for her Graves ophthalmopathy .
Patient was referred to endocrinologist who discussed with her options of treatment
with each side effect. She preferred methimazole and refused radioactive iodine
ablation. The physician advised for a follow-up visit with the results of thyroid function
test that should be repeated four days prior to her follow-up visit.