Nervousness Anxiety and Mental State Sue presents with hand

Nervousness, Anxiety and Mental State

Sue presents with hand tremors and insomnia that began a couple weeks ago. Her husband notes that Sue has been quite irritable lately. Sue has lost 15 pounds over the past month and she has been eating the same amount of meals. On evaluation, there is an enlargement of her anterior neck along with bilateral exophthalmos. There was an elevation of her thyroid hormone levels along with a decrease in her serum TSH levels. Tachycardia was seen at rest. Radioactive iodine was used to confirm her diagnosis as the test showed an increased uptake of the iodine at the thyroid. Thyroid antibodies were also present.

1. Explain why the radioactive iodine is a useful test in determining a thyroid disease.

2. List 3 differential diagnoses and include your reasoning behind each.

3. What is the best diagnosis? Explain how you came to this conclusion.

4. Explain the pathophysiology of the following signs/symptoms:

Weight loss:

Exophthalmos:

Presence of thyroid antibodies:

Tachycardia:

Solution

Answer 1.

This test is known as “Radioactive iodine uptake test (RAIU)”. In this radioactive iodine is taken as a tracer; and the amount of iodine taken up by the thyroid gland is monitored.

If excess amount of radioactive iodine is taken up, it means that the thyroid gland is taking excess of iodine and producing excess of hormones, T3 and T4; resulting in Grave\'s disease. Please note that excess of thyroid hormones will result in increased metabolism in the human body; which may probably be the reason for weight loss.

Answer 2.

Diagnosis methods for determining thyroid disease

Answer 4.

Pathophysiology behind:

Weight loss: Hyperthyroidism, resulting in excess production of T3 and T4 hormones.

Exophthalmos: Autoimmune condition of the eye. This condition is also known as thyroid eye disease. It occurs mainly in women who smoke.

Presence of thyroid antibodies: Grave\'s disease

Tachycardia: Excess T3 and T4 hormones in blood

** Please post one question at a time; I am saying this especially for Part 4; posting one by one will give you more detailed explanations.