Endocrine Disorders
Case Description
The case involves a 16-year-old girl with a slowly enlarging painless mass in her front neck. Reports of feeling like food are stuck in her upper throat and inability to concentrate. She reports that she had been feeling fatigued and excessive sweating. She did not have proptosis and palpitation but observed to have a fine tremor. Her weight, height, and BMI are within the normal range according to her age. Her menarche was at 14 years. Her maternal aunt has had struma surgical treatment. Her serum T4=15.6 ug/dl and serum T3=210 ng/dl and TSH <0.018 uU/ml and Thyroid Peroxidase Antibody 554.7 IU/ml.
Differential diagnosis
The diagnosis was Graves disease. It presents as a diffusely enlarged thyroid gland. The T3 and the T4 are elevated while the TSH is lower than the normal range.
Toxic nodular goiter also presents with nodular goiter. However, the thyroid hormone levels are not as elevated as in Graves disease, and the thyroid receptor antibodies are absent.
Subacute thyroiditis manifests with thyroid pain and febrile symptoms. In lab results, there are also thyroid receptor antibodies.
TSH producing pituitary adenoma is also a differential diagnosis as T4 and T3 are also elevated. However, unlike in Graves disease, the TSH levels are usually elevated or within the normal range. An MRI reveals a tumor of the pituitary gland, and thyroid receptor antibodies are not present.
Graves disease is an autoimmune thyroid disorder. Graves disease is a condition characterized by hyperthyroidism caused by circulating autoantibodies. It then causes an increase in metabolic rate. The thyroid-stimulating immunoglobulins bind to the thyrotropin receptors. It causes the thyroid gland to enlarge and the follicles to increase thyroid hormone synthesis. The fundamental cause of the disease is unknown and affects women more than men. The origin can either be caused by genetic factors or environmental factors. The condition is mainly diagnosed through the thyroid function tests, radioactive iodine uptake test, and the antibody test. In Graves disease, the T4 levels are usually elevated while the TSH levels are low, signifying an overactive thyroid hormone. The Radioactive iodine uptake shows how much iodine the thyroid gland is using. High levels of iodine show the presence of graves disease. The presence of antibodies in the antibody tests suggests Graves disease.
Treatment
The aim of treatment is mainly to reduce the thyrotoxicity and alleviation of symptoms. The patient was started on 5 mg of Thiamazole once daily. The dosage will be decreased gradually following the serum levels of T4 and TSH. She is also to be closely monitored for side effects of the anti-thyroid medications.
The patient is treated symptomatically. The patient’s diet will involve a reduced iodine intake as well as milk and other dairy products and seafood. These foods are rich in iodine and can exacerbate hyperthyroidism. As she is young, she was monitored for irregularity of the menstrual cycle due to the disease.
The patient requires health education as she is young and needs lifestyle changes. The girl reported she had fatigue and was put on bed rest. The patient will need to avoid exercise that may cause further exhaustion. Due to the fine tremors, she was at risk of injury and had to be careful to avoid any physical injuries.
The disease is common in adults, but in rare cases, it occurs in children. Early diagnosis of the illness and correct treatment is vital in young patients. The disease in pediatrics is an ongoing condition and requires lifelong treatment.