A 65-year-old woman with a history of multinodular goiter complains of increasing nervousness, insomnia, and hea palpitations. She has lost 9 kg over the past 6 months. There is no evidence of exophthalmos. Laboratory studies show elevated serum levels of free T3 and T4. Serologic tests for antithyroid antibodies are negative. Which of the following is the likely endocrinopathy in this patient?
Correct Answer: Thyrotoxicosis
Description: Given clinical features suggests the diagnosis of toxic/hyperfunctional multinodular goiter, resulting in thyrotoxicosis/hypehyroidism. Thyrotoxicosis is a hypermetabolic state caused by elevated circulating levels of free T3 and T4. The most common causes of thyrotoxicosis are associated with hyperfunction of the gland and include the following: Diffuse hyperplasia of the thyroid associated with Graves disease (approximately 85% of cases) Hyperfunctional multinodular goiter Hyperfunctional thyroid adenoma The manifestations in the given patient are due to overactivity of the sympathetic nervous system (nervousness, insomnia, and hea palpitations), increase catabolic metabolism (weight loss). True thyroid ophthalmopathy with proptosis is more common in Graves disease. Some individuals with thyrotoxicosis develop reversible left ventricular dysfunction and "low-output" hea failure, called thyrotoxic or hypehyroid cardiomyopathy. Graves disease is the most common cause of endogenous hypehyroidism, associated with diffuse enlargement of thyroid gland and is characterised by production of autoantibodies against different thyroid autoantigens. Thyroid storm refers to the abrupt onset of severe hypehyroidism, occurs most commonly in patients with Graves disease and probably results from an acute elevation in catecholamine levels.
Category:
Pathology
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