Dr. Shaikh Sadaf
Endocrinology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
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Patient's Query
Hi doctor,
A 51-year-old female is presenting with abnormal thyroid functions, primarily manifesting as hot flashes. Notably, her TSH (thyroid stimulating hormone) is low at 0.088, and FT-4 is recorded at 0.99. A thyroid ultrasound revealed an enlarged thyroid, while a fine-needle aspiration (FNA) demonstrated the presence of inflammatory cells. Additionally, TSH receptor antibodies are elevated, measuring 8.2 mg/dl.
Hi,
Welcome to icliniq, and thank you for choosing us as your health care provider.
I understand your medical condition, and I am here to support you.
I have reviewed your inquiry, and while it seems that the 51-year-old woman may have hyperthyroidism, I would need to personally examine the laboratory results and ultrasound report to formulate an appropriate management plan. It is worth noting that hot flashes could potentially be related to menopause rather than the thyroid gland. Kindly attach the relevant reports for a more accurate assessment.
Thank you for choosing iCliniq, and I wish you a pleasant day.
Thank you.
Patient's Query
Hi doctor,
Thank you for the reply.
Laboratory and thyroid report with FNA (fine-needle aspiration) is here.
Hi,
Welcome back to icliniq.com.
Thank you for providing the reports; I appreciate it. (the attachment is removed to protect the patient’s identity). Could you please provide information about any other medical conditions she may have and whether she is currently on any long-term medications? Unfortunately, the patient is diagnosed with mild hyperthyroidism, indicating an overactive thyroid gland. I recommend initiating the following treatment plan:
1. Tablet. Carbimazole 15 milligrams once daily for four weeks. After this period, recheck her thyroid function test.
2. Tablet. Propranolol 10 milligrams three times a day, if there are no contraindications related to heart, allergies, or if she is not already on a beta blocker.
Additionally, given her elevated MCV (mean corpuscular volume) it is advisable to check her vitamin B12 and folate levels. If deficient, appropriate treatment will be necessary. Considering her high cholesterol levels, Tablet. Rosuvastatin 10 milligrams is recommended once daily at night for six months.
Once more, thank you for allowing us to be of service to you.
We value the high level of confidence you have in us!
Patient's Query
Hi doctor,
Thank you for the reply.
Please, I have more questions.
Hi,
Welcome back to icliniq.com.
I regret to inform you that I am unable to make phone calls myself. Ideally, the most effective solution would be a thyroidectomy, given the enlarged but benign nature of the gland. However, it may be prudent to initially explore non-surgical treatment options and monitor the condition. If the enlarged thyroid is causing compressive symptoms, surgical intervention can be considered. Please note that the entire report is in Arabic.
Once more, thank you for allowing us to be of service to you.
We value the high level of confidence you have in us!
Patient's Query
Hi doctor,
Thank you for the reply.
You mentioned that eventually, a thyroidectomy may be necessary. How long can she delay the surgery, and what is the rationale for waiting if surgery is inevitable? Additionally, has she been diagnosed with Graves' disease based on the information provided?
Hi,
Welcome back to icliniq.com.
Hyperthyroidism is typically caused by Graves' disease, an autoimmune condition where the body's immune system targets the thyroid. The primary approach for treatment involves medical interventions. If medication fails to reduce thyroid hormone secretion and the gland becomes significantly enlarged, leading to breathing or swallowing challenges, surgical removal may be considered. The initial strategy is to initiate medical treatment and monitor for symptom improvement. If symptoms persist or worsen, and especially if there are complications such as difficulty swallowing or breathing, or markedly elevated T4 (tetraiodothyronine) or T3 (triiodothyronine) levels, surgical removal becomes a potential option.
In cases where thyroid eye disease develops, surgical intervention might be necessary. Otherwise, close observation may be recommended.
Once more, thank you for allowing us to be of service to you.
We value the high level of confidence you have in us!
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Endocrinology
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