Endocrine Abstracts

A female patient in her early forties was referred to the endocrine clinic. She initially presented to her general practitioner with symptoms of leg cramps and feeling lethargic. As part of initial investigation, thyroid function tests were performed which revealed Free T4 >100 pmol/lwith a TSH suppressed <0.02mU/l. She was promptly commenced on carbimazole for thyrotoxicosis. On retrospective questioning, there was history of weight loss greater than one stone, over the last twelve months. There was also increased appetite, and increased frequency of bowel movements. There was no changes noted in menstruation which remained regular. There was history of occasional palpitations. No mood changes were noted and neither any change in vision or diplopia. Interestingly, there was maternal family history thyrotoxicosis requiring thyroidectomy. Her work pattern consisted of long shifts in the healthcare sector and she was a non-smoker. On examination, the patient was normotensive, with regular pulse and normal heart rate. The thyroid gland was moderately enlarged and no bruit was present. There was no pretibial myxoedema and examination of the eyes showed full eye movement with no diplopia. There was slight proptosis with lid-lag observed particularly on upward movement of the eyes, but no lid retraction. There was no periorbital oedema. Subsequent blood test for TSH receptor antibodies was elevated at 11.8 U/l, thus confirming a diagnosis of Graves’ thyrotoxicosis. She was also commenced on propranolol for relief of adrenergic symptoms. Following four months of treatment with carbimazole and propranolol her symptoms were much improved and there was biochemical improvement with Free T3 and T4 within normal limits.

Conclusion: This report describes a case of thyrotoxicosis due to Graves’ disease which had excellent response to anti-thyroid medication with resolution of symptoms and euthyroid biochemistry.