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Thyroid Case: 38-year-old Woman with Insomnia, Anxiety and Hair Loss

by Michael Lazarus, MD

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    00:01 Let's go on to a case.

    00:03 A 38 year old woman comes to see you complaining of insomnia, frequent stools, anxiety, hair loss and muscle weakness in her upper and lower extremities.

    00:13 On exam, her heart rate is at 110 beats per minute and you note that her eyes appear to bulge with visible sclera above and below her iris.

    00:23 What would her thyroid labs show? So clinically, this patient is manifesting siginficant symptoms and signs of thyroid hormone excess.

    00:33 Firstly, the frequent stools, the anxiety and the hair loss, muscle weakness, when put together really suggests that she has an excess of thyroid hormone.

    00:42 When you examine the patient, she is tachycardic, she has an elevated heart rate and her eyes appear to bulge with sclera visible above the iris, this is a hallmark of what we call "Dysthyroid eye disease".

    00:56 Where the effect of excessive thyroid hormone on the eye's most prominent.

    01:01 Patients have proptosis which is the appearance where the eye appears to bulge in the orbit and the lid of the eye is retracted, such that you're able to see the sclera above the iris.

    01:16 The conclusion of this case is that the patient's clinical presentation is significant for most likely, Graves' disease.

    01:24 We can confirm this diagnosis by checking some labs.

    01:27 Her TSH will be low, and T4 and/or T3 will be elevated, which is the classic hallmark or pattern in hyperthyroidism.


    About the Lecture

    The lecture Thyroid Case: 38-year-old Woman with Insomnia, Anxiety and Hair Loss by Michael Lazarus, MD is from the course Thyroid Disorders.


    Included Quiz Questions

    1. Proptosis is a physical examination hallmark of excessive thyroid production.
    2. Proptosis is a physical examination hallmark of insufficient thyroid production.
    3. Proptosis is absent in patients with excessive thyroid production.
    4. Proptosis is suggestive of thyroid disease but lacks specificity.
    5. Proptosis is suggestive of thyroid disease but lacks sensitivity.
    1. Elevated T3 and T4
    2. Elevated T3 without elevation of T4
    3. Elevated T4 without elevation of T3
    4. T3 testing is not needed for this diagnosis.
    5. T4 testing is not needed for this diagnosis.
    1. ↓ TSH and ↑ T4 and/or T3
    2. ↑ TSH and ↑ T4
    3. ↓ TSH and ↓ T4 and/or T3
    4. ↓ TSH, ↓ T4, and ↑ T3

    Author of lecture Thyroid Case: 38-year-old Woman with Insomnia, Anxiety and Hair Loss

     Michael Lazarus, MD

    Michael Lazarus, MD


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    By Brian A. on 22. October 2019 for Thyroid Case: 38-year-old Woman with Insomnia, Anxiety and Hair Loss

    La explicación fue muy fácil de entender. Me a aclarado as dudas que tenía.