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Case Presentation

Case Presentation. Mohammed Al Houqani. Patient Name: Fatima Age: 32years Sex: Female Nationality: UAE. CC:. Palpitation for 2months Diarrhea for 2months Weight loss for 2months. HPI.

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Case Presentation

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  1. Case Presentation Mohammed Al Houqani

  2. Patient Name: FatimaAge: 32years Sex: FemaleNationality: UAE CC: Palpitation for 2monthsDiarrhea for 2monthsWeight loss for 2months

  3. HPI Fatima is 32 years old local female who was admited with a history of palpitation, diarrhea and weight loss for 2 months duration. she was will 2 months prior to admition when she noticed that her heart is beating faster than usual. It is fast enough that she could feel it. The palpitation was not related to activity. It was Not associated with shortness of breathNot associated with coughNot associated with chest painShe also complained that her bowel habit became more frequent. The stool was normal in color and in consistency. It was not accompanied with mucus or blood. She lost around 5Kg in the past 2months. Fatima can’t tolerate the hot weather and she has excessive sweating when she go out side.

  4. ROS: HEENT: No exophtalmousCVS: No chest pain No SOBResp: No cough No wheezingGI mentioned aboveGenitourinary: OligomenorrheaMusculoskeletal: muscle wastingCNS: became more active

  5. PMH: Not DMNot HypertensiveNo previous admitionNot on any medicationNo History of allergy

  6. Family History: Father is HypertensiveMother is Diabetics No history of Thyroid disease in the family

  7. Social History: Work as a teacher in primary school

  8. O/E: Temp: 37 Pulse: 100b/min regular good volume RR: 16b/min BP:130/86mmHg Patient was laying down comfortableNot on distressNot jaundiceNot cyanosedSweaty hands and warmNo signs of dehydration

  9. O/E: HEENT:Eye: no lid lag, no ophthalmopiegia, no exophthalmusEar drum normalThroat not congestedNo lymphadenopathyThyroid gland: diffusely enlarged and slightly firm thyroid glandthyroid bruit is not audible using the bell of the stethoscope.

  10. O/E: CVS:JVP not raisedNo clubbingNo peripheral edemaApex beat was felt in the 5th intercostal space anterior axillary lineBoth 1st & 2nd heart sounds were normalNo adding sound Resp:Chest were symmetrical, No scaring or deformityBreast move with respirationNormal resonant on percutionNormal bilateral air entry

  11. O/E: Abdomen:Symmetrical with no scaring Soft not tenderNo hepatomegalyNo spleenomegalyKidneys were not palpable CNS:Patient was oriented to time, place and person Fine tremor in her hadsCranial nerves were intactMuscles power 5/5Knee & ankle Reflexes normalBabiniski reflex negative

  12. Impression Hyperthyroidism

  13. Differential Diagnosis: Euthyroid Hyperthyroxinemia Goiter Goiter, Diffuse Toxic Graves Disease Plummer-Vinson Syndrome Struma Ovarii

  14. Investigation: CBC WBC 8 Lymphocytes 32%Monocytes 5%Granulocytes 54%RBC 5.1Hb 14Hct 45%MCV 89.7Plt 250

  15. Investigation: BUE Na 136mEq/lK 4.1 mEq/lCl 99 mEq/lGlucose 100 mg/dl

  16. Investigation: ECG: Normal sinus rhythm

  17. Investigation: TFH: TSH .1 mIU/mLT3: 280ng/dlFree T4:3.8ng/dlTSH-receptor antibodies TSIs positive

  18. Investigation: Radioactive iodine scanning: Increased and the uptake is diffusely distributed over the entire gland

  19. Management Propylthiouracil 400 mg/d PO tid Propranolol 10 mg PO

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