Endocrinology Case 1

A 50 year old female patient with known history of cirrhosis, presented to endocrinology OP with complaints of loss of weight and palpitations of 15 days duration. Clinically she had WHO grade 1 goitre with no discrete palpable nodules. Lab values showed free T4 of 2.84 ng/dl (N- 0.8-2ng/dl), free T3 of 4.9 pg/ml (1.2-4.4 pg/ml) and TSH of <0.05 μIU/ml. Technetium Pertechnetate Thyroid scintigraphy showed homogeneously increased tracer uptake in both lobes of thyroid gland. She was started on Tab. Carbimazole 30 mg per day in 3 divided doses. After 1 month of starting the therapy, she presented with intermittent fever, headaches, sore throat and further weight loss. Complete blood counts showed Hb- 9.6 mg/dl, RBC count – 3.4 M/μL, WBC count of 2500 cells/μL with 10.2% Neutrophils and CRP – 70 mg/L, TSH – 0.02 μIU ml, FT4- 2.04 ng/dl and FT3 – 4.1 pg/ml. What is the diagnosis and according to ATA guidelines which is the best modality of treatment for this patient?

Options:

A. Carbimazole induced Agranulocytosis and best treatment for this patient is to switch over to Propyl thiouracil.

B. Carbimazole induced Agranulocytosis and best suited treatment for this patient is to stop carbimazole and consider for Radioiodine therapy.

C. Thyroid storm and patient should be managed with intravenous Hydrocortisone.

D. Viral fever and should be given supportive care and the medication should be continued.

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