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Risk Factors, Positive TRAb (85), TBL 5.4 MECHANISTIC DIAGRAM, Gerry Guo,…

- - - - Excessive stimulation of thyroid gland
        
        Excessive T4/T3 production
        
        Increased negative feedback onto anterior pituitary
        
        Low TSH
        
        TSH <0.001 mIu/L
        
        Increased expression of beta adrenergic receptors
        
        Increased sympathetic activity
        
        Palpitations
        
        ECG
        
        Fine tremor
        
        Increased activation of GIT smooth muscle
        
        Increased bowel movements
        
        1 more item...
        
        Lid lag + retraction
        
        Gritty eyes
        
        Widened pulse pressure (140/50)
        
        Anxiety
        
        Sleep disturbances
        
        Tachycardia (110 bpm)
        
        Sweating
        
        Beta blockers
        
        Possibly contraindicated due to previous history of asthma? (use beta-1 selective blockers?)
        
        Irritability/difficulty concentrating
        
        Increased uncoupling of metabolism
        
        Increased thermogenesis
        
        Increased BMR
        
        Weight loss
        
        1 more item...
        
        Temperature of 37.2ºC
        
        Heat intolerance
        
        Diaphoreses
        
        Increased inefficiency of ion transport
        
        Increased catabolism of protein in muscle
        
        Proximal muscle weakness
        
        Thionamides (Carbimazole, Propylthiouracil) to reduce thyroid hormone synthesis
        
        Monitor hormone levels and adjust if necessary
        
        Free T4 70 pmol/L
        
        Free T3 27 pmol/L
        
        Goitre
        
        Thyroid uptake scan - increased diffuse uptake across gland (12%)
        
        Increased blood flow
        
        Loud bruits over both lobes
        
        Total thyroidectomy
        
        Decreased T4/T3 production post-operatively
        
        Thyroxine replacement
        
        Annual thyroid function tests
        
        Radioiodine
      - Bind to Fibroblasts
        
        Fibroblast proliferation behind eyes
        
        Proptosis/exophthalmos
        
        Prominent appearance of eyes
        
        Ophthalmologist