Presentation
Palpitations, tremor, anxiety, sweating and recurrent headaches.
Patient Data
The thyroid is enlarged (i.e. a goiter) with heterogeneous echotexture and a few thyroid nodules. No enlarged cervical nodes.
99mTc Sodium Pertechnetate
There is diffusely increased uptake throughout the thyroid gland. No discrete hyper- or hypofunctioning nodules are detected. There is no retrosternal extension. Uptake = 27% (normal 1-4%).
Thyroid function tests demonstrate hyperthyroidism (elevated thyroid hormones with suppressed TSH).
Strongly positive results for thyroid peroxidase antibody (Thy Per Abs) and TSH receptor antibody (TSH R Abs) in keeping with Graves disease.
Mild bilateral proptosis. Enlargement of inferior, medial and superior rectus muscle bellies bilaterally, which is mildly asymmetrically larger on the left.
Case Discussion
This is a case Graves disease with classic presentation of thyrotoxicosis confirmed with laboratory results. Ultrasound findings are non-specific and typically demonstrate an heterogeneous goiter. 99m Tc pertechnetate demonstrates homogeneously increased uptake.
Thyroid associated orbitopathy affects up to 25% of patients, can can develop after hyperthyroidism has been treated.
Unable to process the form. Check for errors and try again.