Presentation
Young male adult aged twenty five years complaining of anterior neck swelling, tremor. Clinically, hyperthyroidism.
Patient Data
Diffuse thyromegaly. The thyroid gland lobes are symmetrically enlarged with conspicuous hetero-hypoechogenic glandular reflectivity punctuated with echogenic transverse linear strands accompanied with accentuated vascularity on color/power flow Doppler mapping. The isthmus is involved. Volumetric assessment yields 27.1 cc for the right lobe and 26.5 cc for the left lobe. The isthmus is involved and spans 0.48 cm (in the AP dimension).
Biochemistry laboratory test findings:
Assay Result Range Interpretation
TSH < 0.0083 uIU/mL 0.35-4.94 uIU/mL <
Free T4 57.54 pmol/L 9.01- 19.05 pmol/L HIGH
Free T3 > 30.72 pmol/L 2.43- 6.01 pmol/L >
Case Discussion
In this illustration, besides the extensive thyroid gland enlargement with symmetrical moderate retrosternal extension, both lobes show no nodularity. The sonographic and the clinical suspicions for hyperthyroidism were strengthened unequivocally with laboratory tests findings. Also notable is that, In immuno-molecular thyroid functional diagnosis;
a). High TSH levels, low T4/T3 levels suggest primary hypothyroidism.
b). Normal or low TSH levels, low T4 suggests secondary hypothyroidism.
c). Low TSH levels, high T4/T3 levels suggests primary hyperthyroidism.
d). High TSH, high levels T3/T4 levels suggests secondary hyperthyroidism.