Case study ( 7688 views as of June 18, 2019 )
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.Author: Dr. Richard Bebb