Graves' Disease - A Newly Diagnosed Patient " Nathalie a recent immigrant "

Case study ( 6783 views as of September 19, 2018 )

Nathalie recently immigrated to your country. She was previously well, but reports 5 months of progressive heat intolerance, an increased tendency to sweat, a fast heart rate, a mild tremor to her hands, and she has lost 12 pounds despite noting an increased appetite. She also reports her periods are lighter. Nathalie complains of a gritty feeling in her eyes with an ache when she looks upwards. She is on no medication and takes no supplements. Her mother has an underactive thyroid and takes thyroid pills.

On physical exam she has warm, moist skin with an obvious tremor on the outstretched arm. Her thyroid is enlarged at approximately 3 times normal size and is non-tender. Her eyes are slightly red but otherwise normal.

Lab results reveal Nathalie's thyroid hormone thyroxine (T4) level is elevated at 48. Her thyroid stimulation hormone (TSH) is unmeasureable. A 24-hour nuclear medicine uptake and scan shows an enlarged thyroid gland with uniform uptake of the tracer and the uptake percentage 78% at 24 hours. This confirms the diagnosis of Grave’s disease.

She is concerned about excessive weight gain after treatment of her overactive thyroid. Also, she is planning to attempt conception for her first child in 18 months and wants to know how to manage this safely. She inquires about the safety of thyroid hormones and inquires about the available options to replace thyroid hormone if she becomes hypothyroid (underactive thyroid) as a result of therapy.

Nathalie needs to continue seeing her Endocrinologist for support and proper management of her newly diagnosed Grave's disease, particularly if she achieves her desired pregnancy. She would benefit from seeing a dietitian and a personal trainer regarding any weight gain experienced. A family physician or Obstetrician could help her plan and manage a pregnancy along with her newly diagnosed condition.

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Conversation based on: Graves' Disease - A Newly Diagnosed Patient " Nathalie a recent immigrant "

Graves' Disease - A Newly Diagnosed Patient " Nathalie a recent immigrant "

  • the case study mentions that Natalie was experiencing heat intolerance. Why would Graves' disease cause heat intolerance ?
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    • @K.Michael - I have read that a slower metabolism can cause feelings of being cold, because of the thyroid's role in regulating metabolism.
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    • So conversely could always being cold be an indication of a slower metabolic rate ?
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    • Hyperthyroidism increases metabolic rate, which will have an effect on Natalie's thermoregulation. Since her metabolism is working at a higher rate than normal, her internal temperature will also be higher than normal. So, any external heat that Natalie experiences will be especially difficult for her body to manage. This plays into the weight loss Natalie noticed - a higher metabolic rate means that her body is using up the nutrients she's taken in through diet much quicker. She's hungrier but losing weight since her diet is no longer adequate to maintain her weight.
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  • As I understand from my family physician and endocrinologist Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause and you should be consulting your own family physician if you think you are suffering from this..
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    • @Michelle Kaarto - that's so interesting! The way I read the case study was that Grave's and hyperthryroidism were both present but I didn't realize Grave's disease cause the hyperthyroidism.
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    • @K.Michael - Graves' disease is the leading cause of hyperthyroidism so I would imagine the symptoms are similar. Perhaps one of our endocrinologists can weigh in on this?
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    • Does Graves' Disease present with different symptoms than hyperthyroidism ?
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  • Aside from the medication, does Grave's disease present any concerns for pregnant women ? What about breastfeeding ?
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    • I know that pregnancy can cause changes in a woman's thyroid function, and that can affect the baby's development, so continuing to be followed by an OB/GYN and an endocrinologist is important, particularly in the early stages of pregnancy. As far as breastfeeding, there is not a significant amount of medication that passes through breastmilk but talking to a clinical pharmacist would definitely help a woman with Graves' disease understand any considerations as far as medications are concerned.
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  • Is it relevant at all that Natalie is newly immigrated to Canada ? Could she have been living with Grave's disease for years but exhibiting no symptoms until she came here ie) climate change ?
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    • I'm unsure about the effects of climate on this sort of condition, but since Graves' is congenital it seems to me that something triggered these responses upon her arrival. Since iodine is a crucial component of the thyroid hormones, would iodine intake be worth taking into consideration? Depending on where she is from, her iodine intake may not have been sufficient but her overactive thyroid could have made up for the inadequacy - effectively mitigating observable effects of Graves'. Canada's regulation of iodine-fortified salt may have increased her iodine intake significantly enough to further stimulate thyroid hormone production leading to these very apparent signs of Graves' disease.
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  • Why does she think will gain weigh with her treatment plan??!
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    • An overactive thyroid would cause you to have a faster metabolism. The medication could slow your metabolism and possibly lead to weight gain
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  • Is Graves' disease an autoimmune disease?
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  • Can someone please elaborate on what the grittiness in her eyes and ache when looking up could indicate in relation to Grave's Disease?
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    • I had a friend with Graves' disease and her eyes somewhat bulged.. Eye symptoms definitely come with this disease.
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  • What are the symptoms of Graves Disease ? How is it diagnosed and treated ?
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  • Is Grave's disease preventable? Hereditary? What causes Grave's disease?
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    • I don't think it can be prevented.
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    • Pretty sure it is hereditary. Both my mother and I have hupothyroidism. I imagine it's the same with Graves.
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    • I thought that most thyroid conditions were hereditary. I would imagine that Grave's Disease would be as well
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