Presentation
Shortness of breath and intermittent palpitations for four days.
Patient Data
The right thyroid measures 9.0 x 5.3 x 4.6 cm, with a volume of 104.5 mL.
The left thyroid measures 8.8 x 5.0 x 4.8 cm, with a volume of 100.5 mL.
The thyroid isthmus measures 1.2 cm.
Bilateral thyroid glands demonstrate heterogenous echotexture and diffusely increased vascularity. This is suggestive of Graves' disease versus Hashimoto thyroiditis.
Case Discussion
This represents a case of graves disease. The patient with a medical history of congestive heart failure and hypertension presented to the emergency department with a 4-day onset of the aforementioned symptoms. Laboratory evaluation revealed low TSH (<0.015 mcIU/mL) and elevated free T4 (5.54 ng/dL) and T3 (521.0 ng/dL). After stabilization, the patient was started on methimazole, 20 mg, with the suggestion for regular follow-up with an endocrinologist.
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