Endocrine cases

Help please!

Case 1: A 50-year-old woman presents with an anterior neck enlargement. She reports increased appetite, weight loss, and frequent bowel movements over the past month. She is 5'8" tall & weighs 150 lb. Resting heart rate is 84 BPM, & BP is 112/78 mm Hg. She seems to “stare,” & her eyelids close incompletely. Palpation reveals that the thyroid gland is enlarged. It weighs an estimated 40g (normal = 15-20g).

The test results for this patient were as follows (S = measured in serum):

                                                  Patient's value   Normal range
Calcium, total (S)                       10.2 mg/dl           8.4 - 10.2
Phosphorus                                 4.6 mg/dl            2.7 - 4.5
Alkaline phosphatase (S)           130 U/L              49 - 120
T4, Total (S)                               12.2 ug/dl            5 - 11.5
T3, Total (S)                               311 ng/dl            100 - 215
TSH (S)                                      <0.1 uU/ml         0.7 -7.0
Free thyroxine index (FTI)         14.6                    6 - 11.5

Uptake of radioactive iodine into the thyroid gland showed 68% uptake at 6 hr with radioactive iodine (normal is 5% - 28% uptake).
Serum was obtained for anti-thyroid antibody tests:
                                           Patient         Normal
Antithyroglobulin Ab.          neg.            neg.
Antimicrosomal Ab.             pos.            neg.

What is your diagnosis? Provide evidence (signs and symptoms) to support your answer completely.




How should this patient be treated?