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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Describe the signs, symptoms, and laboratory parameters associated with hyperthyroidism, and relate them to the pathophysiology of the disease.

  • Select and justify appropriate patient-specific initial and follow-up pharmacotherapy for patients with hyperthyroidism.

  • Develop a plan for monitoring the pharmacotherapy for hyperthyroidism.

  • Provide appropriate education to patients receiving drug therapy for hyperthyroidism.

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PATIENT PRESENTATION

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Chief Complaint

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“My heart feels like it is racing, and I feel jittery.”

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HPI

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Carrie Gibson is a 23-year-old woman who presents to her PCP with complaints of palpitations and a fine tremor. The palpitations started a few months ago and would come and go until the past week when they began occurring more frequently, almost daily. She denies CP. She reports that she began noticing a fine tremor approximately 3 weeks ago. She also reports loose stools and a 5-kg weight loss over the past 6 months, despite a good appetite and food intake. She feels hot all of the time and sweats a lot. She further states that she has been losing her hair recently and that she is more irritable than usual.

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PMH

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She has been healthy up to this point with no medical conditions. She reports having had “the flu” last November, but states that she did not seek medical attention at that time.

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FH

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Father has HTN; mother had a history of Graves disease and passed away 1 year ago from breast CA at age 53. Her oldest sister is 32 years of age and has breast CA; she has two other sisters, ages 29 and 25, and one brother, age 27, all of whom are healthy. Her aunt (mother’s sister) and grandmother both had Graves disease.

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SH

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She smokes 1.5 ppd × 5 years and drinks alcohol socially on the weekends (“a few drinks on Fridays and Saturdays”).

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Meds

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Drospirenone/ethinyl estradiol daily

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All

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None

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ROS

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She reports no visual changes, CP, or dyspnea. She has occasional N/V/D.

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Physical Examination

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Gen
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Patient is a thin, tanned WF in NAD. She appears anxious and has a fine motor tremor in her hands.

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VS
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BP 136/80 mm Hg, P 120 bpm, RR 18, T 38.1°C; Wt 48 kg, Ht 5′6″

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Skin
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Hair is fine and sparse in the temporal area

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HEENT
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PERRL, EOMI, (+) lid lag, no proptosis (no ophthalmoplegia) or periorbital edema

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Neck/Lymph Nodes
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