Question

A 45-year old female with history of Grave disease visits your clinic two weeks ago after her thyroidectomy complaining of intermittent muscular aches and spasms (tetany) as well as a tingling sensation of the legs, lips, and tongue. Her reflexes are hyperactive on exam. What complications of Grave disease does she suffer from? What is Grave disease and how is it differentiated from other thyroid diseases-what laboratory tests and results indicate that an individual has Grave disease? What are the characteristic findings in Grave disease? What is the purpose of the thyroidectomy and what are treatments are available? What is the long term prognosis for a patient with Grave disease? Answer in at least 10 complete sentences for full credit

Answer 1

She is suffering hypocalcemia which has lead to tingling sensation of legs,lip and tongue with muscle aches and spasm due to thyroidectomy. It may be because of the removal or insult of parathyroid glands causing decreased or no production if calcium.

Grave disease is an autoimmune problem of the thyroid gland leafing to increased thyroid hormone. It is also called as Toxic diffuse goitre.

The two main things which can differentiate thyroid disease from Grave disease are

• Exopthalmos
• Non pitting edema i.e.,pretibial myxedema

Lab test:

• Radio iodine uptake
• TSH levels
• Total T3 and T4
• Free T4
• Thyroid stimulating immunoglobulin
• Thyroid peroxidase antibody

Characteristic finding in Grave disease

• Puffy eyes
• Anxiety,irritability
• Insomnia
• Muscle weakness
• Tachycardia
• Weight loss despite good appetite
• Health intolerance
• Thickening of the skins of shins
• Exopthalmus
• Hair loss
• Fatigue

Thyroidectomy is done to cease the production of increased thyroid hormone production causing this disease

Treatment:

• Thyroid hormone therapy
• Calcium supplements
• Beta blockers to reduce sympathetic nervous stimulations and causing tachycardia and nausea
• Radioiodine therapy

Prognosis

Surgical intervention with proper medication and follow up has a good prognosis and has reduced the number of death.