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Thyrotoxicosis Case Study Ppt Sample

Shannon was diagnosed with Graves’ disease when she was four years old. Here, both Shannon and her mum Michelle explain what it was like.

Michelle: ‘Being a first time parent l didn’t notice anything wrong with Shannon except she was a bit hyper which l thought was normal for three to four year olds.

'The health visitor who visited me after I had my son started asking questions about Shannon’s eyes. She noticed that her eyes looked a lot bigger in one photo than they had in an earlier photo. Then she asked me some questions: Is she hyperactive? Yes. Does she feel cold? No. She asked me to get Shannon’s bloods taken for thyroid, even though she said it would be very rare for her to have it.

'Shannon was diagnosed with Graves’ disease. The paediatrician had never had to treat someone so young so they had to liaise with doctors in Oxford. First they had to give heart medicine to slow her heart rate down (beta-blockers), then decide how much carbimazole and levothyroxine to give as she followed a 'block and replace' regimen.

'We were back and forth every month to get the right doses. It wasn’t until Shannon was nine that it was right. Now we are waiting for her to go into hospital where she will have her thyroid removed.'

Shannon: 'As l was only four when I was diagnosed, l can’t really remember what it was like. l can’t say l was ill. l know that people say that they don’t know how mum coped as l was always up and about in the early hours and then would just go to sleep at any time during the day. I would then be up and running about again an hour later. l would wear a coat which mum said l would always take off even in the snow as l was always hot.

'I had a blood test and within a few weeks l was seeing a doctor at the hospital. They gave me medicine for my heart. l remember him saying to my mum ‘if she wants sweets, let her’ as my body was using so much energy l needed it, which l thought was cool… although now l don’t eat a lot of sweets as it must have put me off eating so many!

'I am a lot older now and still on medication. They stopped my thyroid working and then had to give me levothyroxine to replace the hormones (the block and replace regime). l am now waiting to see when they will take my thyroid out, but l feel fine.

'My advice to other children with a thyroid condition is not to worry about it, talk to people about it and take your medication. Most people won’t even know that you have a thyroid condition.'

  • Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med. 2004 Aug 9-23. 164(15):1675-8. [Medline].

  • [Guideline] Bahn Chair RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011 Jun. 21(6):593-646. [Medline].

  • [Guideline] Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016 Oct. 26 (10):1343-1421. [Medline]. [Full Text].

  • Lumbroso S, Paris F, Sultan C. Activating Gsalpha mutations: analysis of 113 patients with signs of McCune-Albright syndrome--a European Collaborative Study. J Clin Endocrinol Metab. 2004 May. 89(5):2107-13. [Medline].

  • Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev. 2002 Jun. 23(3):327-64. [Medline].

  • Plagnol V, Howson JM, Smyth DJ, Walker N, Hafler JP, Wallace C, et al. Genome-wide association analysis of autoantibody positivity in type 1 diabetes cases. PLoS Genet. 2011 Aug. 7(8):e1002216. [Medline]. [Full Text].

  • Chu X, Pan CM, Zhao SX, Liang J, Gao GQ, Zhang XM, et al. A genome-wide association study identifies two new risk loci for Graves' disease. Nat Genet. 2011 Aug 14. 43(9):897-901. [Medline].

  • Simmonds MJ, Brand OJ, Barrett JC, Newby PR, Franklyn JA, Gough SC. Association of Fc receptor-like 5 (FCRL5) with Graves' disease is secondary to the effect of FCRL3. Clin Endocrinol (Oxf). 2010 Nov. 73(5):654-60. [Medline]. [Full Text].

  • Newby PR, Pickles OJ, Mazumdar S, Brand OJ, Carr-Smith JD, Pearce SH, et al. Follow-up of potential novel Graves' disease susceptibility loci, identified in the UK WTCCC genome-wide nonsynonymous SNP study. Eur J Hum Genet. 2010 Sep. 18(9):1021-6. [Medline]. [Full Text].

  • Nakabayashi K, Shirasawa S. Recent advances in the association studies of autoimmune thyroid disease and the functional characterization of AITD-related transcription factor ZFAT. Nihon Rinsho Meneki Gakkai Kaishi. 2010. 33(2):66-72. [Medline].

  • Chu X, Dong Y, Shen M, Sun L, Dong C, Wang Y, et al. Polymorphisms in the ADRB2 gene and Graves disease: a case-control study and a meta-analysis of available evidence. BMC Med Genet. 2009 Mar 13. 10:26. [Medline]. [Full Text].

  • Gabriel EM, Bergert ER, Grant CS, van Heerden JA, Thompson GB, Morris JC. Germline polymorphism of codon 727 of human thyroid-stimulating hormone receptor is associated with toxic multinodular goiter. J Clin Endocrinol Metab. 1999 Sep. 84(9):3328-35. [Medline].

  • Mittra ES, Niederkohr RD, Rodriguez C, El-Maghraby T, McDougall IR. Uncommon causes of thyrotoxicosis. J Nucl Med. 2008 Feb. 49(2):265-78. [Medline].

  • Davies TF, Larsen PR. Thyrotoxicosis. Larsen PR et al, eds. Williams Textbook of Endocrinology. 10th ed. Philadelphia: Saunders; 2003. 374-421.

  • Dahl P, Danzi S, Klein I. Thyrotoxic cardiac disease. Curr Heart Fail Rep. 2008 Sep. 5(3):170-6. [Medline].

  • Zhyzhneuskaya S, Addison C, Tsatlidis V, Weaver JU, Razvi S. The Natural History of Subclinical Hyperthyroidism in Graves' Disease: The Rule of Thirds. Thyroid. 2016 Jun. 26(6):765-9. [Medline].

  • Heeringa J, Hoogendoorn EH, van der Deure WM, et al. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med. 2008 Nov 10. 168(20):2219-24. [Medline].

  • Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002 Feb. 87(2):489-99. [Medline]. [Full Text].

  • Porterfield JR Jr, Thompson GB, Farley DR, Grant CS, Richards ML. Evidence-based management of toxic multinodular goiter (Plummer's Disease). World J Surg. 2008 Jul. 32(7):1278-84. [Medline].

  • [Guideline] De Groot L, Abalovich M, Alexander EK, Amino N, Barbour L, Cobin RH, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012 Aug. 97(8):2543-65. [Medline].

  • FDA MedWatch Safety Alerts for Human Medical Products. Propylthiouracil (PTU). US Food and Drug Administration. Accessed: June 3, 2009. Available at

  • Stalberg P, Svensson A, Hessman O, et al. Surgical treatment of Graves' disease: evidence-based approach. World J Surg. 2008 Jul. 32(7):1269-77. [Medline].

  • Wang J, Qin L. Radioiodine therapy versus antithyroid drugs in Graves' disease: a meta-analysis of randomized controlled trials. Br J Radiol. 2016 Jun 27. [Medline].

  • Sisson JC, Freitas J, McDougall IR, Dauer LT, Hurley JR, Brierley JD, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine ¹³¹i: practice recommendations of the american thyroid association. Thyroid. 2011 Apr. 21(4):335-46. [Medline].

  • Shindo M. Surgery for hyperthyroidism. ORL J Otorhinolaryngol Relat Spec. 2008. 70(5):298-304. [Medline].

  • Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, et al. Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg. 2008 Dec. 248(6):1060-6. [Medline].

  • Zhang Y, Dong Z, Li J, Yang J, Yang W, Wang C. Comparison of endoscopic and conventional open thyroidectomy for Graves' disease: A meta-analysis. Int J Surg. 2017 Feb 22. 40:52-9. [Medline].

  • FDA Drug Safety Communication: New Boxed Warning on severe liver injury with propylthiouracil. US Food and Drug Administration, April 21, 2010. Available at Accessed: March 6, 2012.

  • Yalamanchi S, Cooper DS. Thyroid disorders in pregnancy. Curr Opin Obstet Gynecol. 2015 Oct 19. [Medline].

  • Burches-Feliciano MJ, Argente-Pla M, Garcia-Malpartida K, Rubio-Almanza M, Merino-Torres JF. Hyperthyroidism induced by topical iodine. Endocrinol Nutr. 2015 Aug 12. [Medline].

  • Brandt F. The long-term consequences of previous hyperthyroidism. A register-based study of singletons and twins. Dan Med J. 2015 Jun. 62 (6):[Medline].

  • Srinivasan S, Misra M. Hyperthyroidism in children. Pediatr Rev. 2015 Jun. 36 (6):239-48. [Medline].

  • Gupta MK. Thyrotropin-receptor antibodies in thyroid diseases: advances in detection techniques and clinical applications. Clin Chim Acta. 2000 Mar. 293 (1-2):1-29. [Medline].

  • Feldt-Rasmussen U, Hoier-Madsen M, Bech K, et al. Anti-thyroid peroxidase antibodies in thyroid disorders and non-thyroid autoimmune diseases. Autoimmunity. 1991. 9 (3):245-54. [Medline].