OSCE Station 4.32 year old woman presents with a neck swelling and 112 history of palpltations, irritability and tow: ‘What is the likely diagnosis? ‘Hyperthyroidism os What other specific emptoms would support this diagnosis ? (0.5 each) Fatigue ‘Weakness ‘sweating Stanng Heat intolerance Gritty eyes soB ‘Swelling around eyes Tremor Increased appeute tnoreased BA Oligomenorthoea i ‘nar signs would you ook for n this lady ¢ General:- Amity Low ‘ianas= Tnyroia acropacny Palmar erythema ‘Warm, sweaty hands rime wemor Pulse:- Tachycardia AF Neuro feuvial myxoeuema Proximal myopathy Hyperreflexia Eye iypunts td mg 2xopthalmos ‘Lid retraction Chemosis Comeal ulceration Opthalunspleyia ‘Coujuneviis Necic- Goitre ‘Thyroid bruit N10 ‘What investigations should be performed? FBE ‘Autoantibody test (antithyroglobulin test) Tr Ultrasound ECG ‘?PRadicisctope scan “Ta Waae wreatnent options ae there for hyper thgrviseem? Medical:- Propriothiouraci! Radiosetive iodine : Propranolol Surgical- Partial thyroidectomy a What isthe most common cause of hyperthyrotdism in this lady? Graves’ Disease 0S What would be the ideal treatment for her Casbimnazole of PTU va TOTAL 20 ‘What complications can arise is leftuntreated? (Bomus merks- time permitting) 1) Condiae disase - AF, CCP 2) Increased osteoporosis - reduced bone density 3) Graves opthalmopathy - comeal uleerston, optic nerve compression, intemuclear opthalmoplegia