First examination (1st row of images)

Clinical data: a 29-year-old woman requested a second opinion. She was treated for Graves' disease for 2 months. The TSAb was initially 8.9 U/L, the FT4 was 54.2 pM/l. She get 30 mg methimazole therapy. Her complaints have already decreased.

Palpation: no abnormality.

Results of blood tests: hyperthyroidism - TSH undetectable, FT4 29.2 pM/L, FT3 8.91 pM/L.

Ultrasonography: the thyroid was minimally enlarged and moderately hypoechogenic. The vascularization was a bit increased.

The dose of methimazole was reduced to daily 15 mg.

Second examination 9 months later (2nd row of images)

Clinical data: the patient had no complaints except for a 6 kg weight in gain.

Palpation: unchanged.

Results of blood tests: euthyroidism on daily 10 mg methimazole (TSH 3.58 mIU/L, FT4 12.7 pM/L).

Ultrasonography: compared with the first examination the thyroid has decreased in size and the echo structure became less hypoechogenic. The vascularization was unchanged.

Suggestion: daily 5 mg methimazole.

Third examination 24 months after initial investigation (3rd row of images)

Clinical data: the thyrostatic therapy was stopped for 13 months. The patient had no complaints.

Palpation: unchanged.

Results of blood tests: euthyroidism (TSH 0.52 mIU/L, FT4 14.6 pM/L).

Ultrasonography: the size of the thyroid decreased further. The echo structure and the vascularization became normal.

Suggestion: to check the thyroid function every year in the event of complaints or pregnancy at once.

Comment. The typical course of Graves disease in a favorable case is demonstrated here. The change in hormone levels and in the ultrasound pattern are parallel.

 

 

 

 

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