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Graves' disease - Case 30.

Nodular goiter

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First examination (first row):

Clinical presentation: a 31-year-old woman was referred for an evaluation of hyperthyroidism. 

Palpation: both lobes were enlarged and nodular.

Results of blood tests: hyperthyroidism with undetectable TSH-level. FT4 was 65.6 pM/L. TSAb-assay 12 U/L (normal value under 1.5).

Ultrasonography: a hypoechogenic, enlarged thyroid was found with increased vascularization.

Daily 30 mg methimazole was administered.

8 months after initial investigation (second row):

Clinical and laboratory data: the patient was well and euthyroid on daily 10 mg methimazole and 50 microgram levothyroxine: TSH 0.12 mIU/L, FT4 15.8 pM/L.

Ultrasonography: the thyroid became smaller and less hypoechogenic. The vascularization was average.

The patient was treated another five months with methimazole and levothyroxine. Thereafter the therapy was discontinued.

21 months after initial investigation (third row):

Clinical and laboratory data: the patient had no complaints. She was euthyroid 8 months after the discontinuation of thyrostatic therapy.

Ultrasonography: the thyroids were echonormal, the vascularization was decreased.

 

 

 
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