CASE OF THE MONTH

 

PRESENTED BY

THE THYROID SURGERY CENTER OF TEXAS, P.A.

1927 Lohmans Crossing Road, Suite 201, Austin, TX 78734

www.thyroidcancer.com

512-608-9595; Fax-512-608-9833

 

GRAVES´ DISEASE

 

History/Findings:       The patient is a 22 year old female college student from Waco, referred to the center by an Austin endocrinologist.  She was diagnosed with Graves’ Disease in January of this year and started on Tapazole and Toprol.  Mild to moderate exophthalmos was present.  She and her family were already well informed about hyperthyroidism, and she was well versed in the various treatment options available to her.  As a young female of child bearing age, she rejected the idea of radiation exposure and she also did not want to take long term anti thyroid medication.  Total Thyroidectomy was the treatment plan that she and her family chose.

 

Lab/Imaging:  

Jan/03 

• T4  25.2 (n=4.4–12.5)
• T3 Uptake 52.5 (n=20-38.5)  TSH <.01

Feb/03 

• Thyroid scan & Uptake – 24 hour uptake 85%, diffusely enlarged gland.

Jun/03  

• Free T4 1.8 (n=0.8-1.8)   Free T3 690 (n=230-420)   TSH <.01

Clinical Course:  With return of her thyroid function tests to normal and near normal, the patient was started on SSKI 10 days prior to surgery.  Total thyroidectomy was performed as an outpatient in early July.  Her post operative calcium levels were normal and she was started on a low dose of Synthroid and referred back to her endocrinologist for further care and thyroid hormone maintenance.

Final Pathology: TOTAL THYROIDECTOMY- Changes consistent with Graves’Disease; left sided parathyroid tissue was identified with the specimen.  An adjacent lymph node was benign.

Comments:  Total thyroidectomy is well proven as a quick, safe, and efficient treatment plan for patients with Graves’ Disease.  Of all the therapeutic options, total thyroidectomy probably offers the best opportunity for improvement and perhaps even resolution of the occulopathy that sometimes accompanies this disorder.  Radioactive iodine therapy and long term anti thyroid medication are also acceptable treatment options.  As with most therapies, the treatment plan should be tailored to the patient’s best interests.

 

“…Thyroid surgery…it’s all we do…”