This is a case on Thyroid Disorders for Medical Students

1. Case for Thyroid Disorders

2. GENERAL DATA
• 21 year old
• Female

3. CHIEF COMPLAINT
• Diarrhea

4. 4 months PTA onset of dysphagia
hoarseness of voice
2 weeks PTA tremors, irritability,
thinning of hair, weight loss,
diaphoresis, prominence of
right eye
3 days PTA onset of watery stool
noticed anterior neck mass
ADMISSION
HISTORY OF PRESENT ILLNESS

5. • CONSTITUTIONAL: weight loss, no fever &
chills, weakness or fatigue.
• SKIN: no rash, no pruritus, no discoloration
• HEENT: dysphagia, hoarseness, no blurring or
loss of vision, no hearing loss, no tinnitus, no
congestion, no runny nose.
REVIEW OF SYSTEMS

6. • RESPIRATORY: no pain, no hemoptysis
• CARDIOVASCULAR: no chest pain, no
palpitations, no edema, no orthopnea
• GASTRO-INTESTINAL: abdominal pain, no
nausea / vomiting, LBM, melena or
hematochezia
• GENITOURINARY: no dysuria, no hematuria,
no discharges
REVIEW OF SYSTEMS

7. • NEURO-PSYCH: no headache, no dizziness,
no syncope, no paralysis, no history of
depression, no anxiety, no hallucinations
• MUSCULOSKELETAL: no arthralgia, no
deformity, no weakness
REVIEW OF SYSTEMS

8. • HEMATOLOGIC: no bleeding, no bruising.
• LYMPHATICS: no painful or enlarged nodes
• ENDOCRINE: diaphoresis, heat intolerance, no
polyuria, no polydipsia, no polyphagia,
REVIEW OF SYSTEMS

9. PAST MEDICAL HISTORY
 No DM, No HPN, No BA, No Arthritis
 No known allergies to food & drugs

10. FAMILY HISTORY
 Hypertension (father side)
 Diabetes Mellitus (father side)
 Bronchial Asthma (mother side)

11. PERSONAL & SOCIAL HISTORY
 Non-smoker
 Non-alcohol beverage drinker

12. OB-GYNE HISTORY
 G2 P2 L1
 G1 = IUFD
 G2 = C/S
 Oral Contraceptives
 Menses every 28 days, 2-3 ppd

13. • Vital Signs: BP: 120/80 HR: 160 RR: 24 T: 36.2
Wt: 42.2 kg Ht: 5’ 1” BMI: 17.5 O2sat: 98%
• General: conscious, coherent, oriented, not in distress
• Skin: warm & moist, no cyanosis, jaundice, hematoma, rashes
• HEENT: anicteric sclerae, pink palpebral conjunctivae, +eyelid
tremor, no lidlag, pupils = 3-4 mm equal, brisk, no discharges, no
tonsillo-pharyngeal congestion, dry lips, sunken eyeballs
• Neck: 4x6 cm right anterior neck mass, firm, well delineated
borders, movable, no scars, no bruits, trachea midline, no neck vein
engorgement
PHYSICAL EXAMINATION

15. • Chest & Lungs:
 symmetrical chest expansion, no lesions, no
retractions
 no tenderness, no mass, equal vocal & tactile
fremiti

PHYSICAL EXAMINATION

16. • Cardiovascular:
 Adynamic precordium
 No heaves/thrills, PMI 5th ICS MCL
 Tachycardic, regular rhythm, distinct s1 & s2,
no murmur
PHYSICAL EXAMINATION

17. • Gastrointestinal:
 flat, 11 cm infraumbilical midline vertical scar
 hyperactive bowel sounds, no bruits
 tympanic abdomen
 no hepatomegaly or splenomegaly, no abdominal
tenderness, soft abdomen
PHYSICAL EXAMINATION

18. • Genito-urinary: no mass, no discharges, no flank
tenderness, bladder not distended
• Extremities: no deformity, full range of motion, full equal
pulses, no pallor, no edema
• Neurologic: conscious, coherent, oriented GCS = 15
normal mental status exam
no cranial nerve deficit
normal cerebellar exam
motor = 5/5 all extremity
sensory = 100% all extremity
DTR = +++
PHYSICAL EXAMINATION

19. PHYSICAL EXAMINATION
• Burch Wartofsky Scoring
• Temp = 36.2 = 0
• Heart rate = 160 = 25
• CHF = bibasal rales = 10
• Arrythmia = none = 0
• GIT = LBM = 10
• CNS = Agitation = 10
• Suggestive Hx = yes = 10
Total = 65 Probable Storm

22. Laboratory Results
• Complete Blood Count
Hgb – 125
Hct – 0.37
RBC – 4.93
WBC – 6.4
neut – 0.48
lymp – 0.33
mono – 0.18
eosi – 0.01
Plt - 163
• Stool Exam
Color – green
Consistency – soft
No ova/parasite seen

23. • Thyroid Panel
TSH – 0.05
FT4 - >100.00
T3 - >12.27
• Blood Examinations
K – 3.34
Na – 136
Mg – 1.72
Crea – 0.39
Ionized Ca – 1.00
RBS – 114.5
BUN – 10
Laboratory Results

24. Guide Questions
• Based on the available data, what is your
admitting impression?
• What are your differential diagnoses?
• Compare the criteria for thyroid storm: Burch
Wartofsky versus Japan criteria
• Correlate the clinical with the laboratory
findings.
• Discuss the plan for management, acute and
long-term.