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Investigations of Hyperthyroidism

Case scenario

A 16 years old boy was referred by his general practitioner for assessment of suspected hyperthyroidism

•    Racing heart
•    Gastric reflux
•    Good appetite
•    No apparent weight gain or loss
•    No diarrhoea

The parents reported that the boy had problems with behaviour and school performance and seemed to be hyperactive

Revealed a
•    Large smooth goitre
•    Thyroid bruit
•    Tachycardia
•    Sweaty plams
•    Proximal muscle weakness

Month Nov Dec Jan Feb Mar Unit Ref Range
fT4 92 53 18 8 3 pmol/L 10-20
TSH <0.1 <0.1 <0.1 0.2 1.1 mIU/L 0.5-4.0
   Decreased fT4               with time

Increased TSH             with time


Grave’s disease (autoimmune condition) where thyroid gland is stimulated by autoantibodies directed against TSH receptors on thyroid cells.

The patient had a
• Overt features of Graves disease (hypothyroidism and goitre)
• Ophthalmopathy
• Absent pretibial myxoedema detected
• Perform tests for thyroid hormone measurement (for confirmation)
• Patient was given carbimazole & TFT’s regularly checked
• Carbimazole act by blocking several TSH-stimulated stages in TH secretion
• Symptoms & signs improved

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