| ABC, a 36-year-old woman, presents with clinical signs of hyperthyroidism with a duration of 2 months. The patient denies the use of any medication, tobacco, or alcohol. She had two prior pregnancies, the last one 10 years before. This was her first episode of hyperthyroidism. On clinical evaluation, she presented goiter (two to three times the normal thyroid size), heart rate of 105 beats per minute, and no signs of orbitopathy. On laboratory evaluation, she had elevated serum free T4 (FT4; 3.6 ng/dL) and suppressed serum TSH (< 0.001 mIU/L) levels. |
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Variation 1
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| ABC, a 36-year-old woman, presents with clinical signs of hyperthyroidism with a duration of 2 months. The patient denies the use of any medication, tobacco, or alcohol. She had two prior pregnancies, the last one 10 years before. This was her first episode of hyperthyroidism. On clinical evaluation, she presented goiter (two to three times the normal thyroid size), heart rate of 105 beats per minute, and clinical activity score (CAS) of 3 (movement-induced pain, palpebral edema, and conjunctival hyperemia), proptosis of 23 mm in both eyes, and eyelid aperture of 10 mm, with no visual loss. On laboratory evaluation, she presented elevated serum FT4 (3.6 ng/dL) and suppressed serum TSH (< 0.001 mIU/L) levels. |
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Variation 2
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| DEF, a 50-year-old man, presents with clinical signs of hyperthyroidism with a duration of 2 months. He had a history of tobacco use and denied the use of any medication or alcohol. This was his first episode of hyperthyroidism. On clinical evaluation, he presented a goiter (two to three times the normal thyroid size), heart rate of 105 beats per minute, proptosis of 14 mm in both eyes, eyelid aperture of 7 mm, no signs of clinical orbitopathy, and no visual loss. On laboratory evaluation, he presented elevated serum FT4 (3.6 ng/dL) and suppressed serum TSH (< 0.001 mIU/L) levels. |
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Variation 3
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| Assuming the patient in the index case was initially treated with an antithyroid drug (ATD) for 18 months and presented with disease recurrence 6 months after discontinuing the ATD, what would be the treatment alternative? |
