A 50 year old female presented to the emergency department with anxiety, palpitations and feeling generally unwell. She had no past medical history and was on no medications. She had, however, seen her GP the week before complaining of 2 weeks of palpitations, anxiety and weight loss. Her GP had checked her thyroid function tests and started her on carbimazole 3 days previously. However, since then her symptoms had worsened. In particular, she was having palpitations, sweats, anxiety, and diarrhoea.
On examination, she looked anxious and jittery with a heart rate of 115, a respiratory rate of 22, and other vital signs which were normal. She was afebrile. She had a fine tremor and the examination was otherwise unremarkable. There was no signs of goitre, proptosis or oedema. There was no clinical evidence of heart failure and her ECG showed sinus tachycardia.
Review of bloods from the GP showed:
TSH <0.01 (0.3-4.5 mU/L)
T3 9.6 (3.0-7.2 pmol/L)
T4 15 (7-17 pmol/L)
She had also had an ultrasound of her neck, that showed a nodule in her thyroid.
See what happens in this case by reading the Thyrotoxicosis Blog.