Question

1. A fifty-five year old woman asks for medical advice following a six month period of restlessness, nervousness and insomnia. Her heart rate is 120 bpm, she has tremors, warm moist hands and an enlarged thyroid gland. What would you predict her T₃ -T₄ blood levels to be, above or below normal? Why? What would you predict her TSH levels to be, and why?

2. A sixty year old man is found comatose. He has dry mucus membranes and a blood glucose level of 650 mg/dL but no ketones in blood. A urine dipstick test is positive for glucose but negative for ketones. What would be your diagnosis and why?

Answer 1

1. The lady can be seen to suffer from hyperthyroidism.

The lady can be seen having increased heart rate associated with restlessness.She also has the hand tremors.

These are the most common symptoms of hyperthyroidism.The patient will have a hypermetabolic state with increased heart rate,blood presssure,insomnia,restlessness,nervousness,dizziness,excessive sweating etc.The thyroid gland may be also swollen due to the goitre.

The T3 and T4 levels will be increased since the tyroid gland produces more of them.The cause for this can be either an autoimmune disorder (graves disease) or toxic /multinodular goitre.