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Case Study: Hyperthyroidism and Graves’ Disease
K.B. is a 65-year-old man admitted to the hospital after a 5-day
episode of “the flu” with complaints of dyspnea on exertion,
palpitations, chest pain, insomnia, and fatigue. K.B. was diagnosed
with Graves’ disease 6 months ago and placed on methimazole
(Tapazole) 15 mg/day. His other past medical history includes heart
failure and hypertension requiring antihypertensive medications;
however, he states that he has not been taking these medications
on a regular basis. Vital signs (VS) are: 150/90, 124 irregular, 20,
100.2 ° F (37.9 ° C). Admission assessment findings are: height 5 ft,
8 in; weight 132 lb; appears anxious and restless; loud heart
sounds; 1+ pitting edema noted in bilateral lower extremities;
diminished breath sounds
with fine crackles in the posterior bases. K.B. begins to cry when he
tells you he recently lost his wife; you notice someone has punched
several more holes in his belt so he could tighten it.
Laboratory Values
Hemoglobin (Hgb) 11.8
g/dL Hematocrit (Hct)
36%
Erythrocyte sedimentation rate (ESR) 48
mm/hr Sodium 141 mmol/L
Potassium 4.7 mmol/L
Chloride 101 mmol/L
Blood urea nitrogen (BUN) 33
mg/dL Creatinine 1.9 mg/dL
Free thyroxine (T4) 14.0
ng/dL Triiodothyronine (T3)
230 ng/dL
[AUTHOR] 1
, 1. Which of K.B.'s assessment findings represent
manifestations of hypermetabolism? Fatigue, sudden weight
loss, tachycardia, irregular heart rate, nervousness, anxiety
2. Interpret K.B.'s laboratory results. Elevated ESR, BUN,
Creatinine, T4and T3
3. You go to assess K.B. What additional data do you need to
obtain because he has Graves’disease? Assess for any tremors, any
weight loss, which medications he is currently taking, Check eyes for
exophthalmos, sweating, muscle weakness, depression, double vision
[AUTHOR] 2
Case Study: Hyperthyroidism and Graves’ Disease
K.B. is a 65-year-old man admitted to the hospital after a 5-day
episode of “the flu” with complaints of dyspnea on exertion,
palpitations, chest pain, insomnia, and fatigue. K.B. was diagnosed
with Graves’ disease 6 months ago and placed on methimazole
(Tapazole) 15 mg/day. His other past medical history includes heart
failure and hypertension requiring antihypertensive medications;
however, he states that he has not been taking these medications
on a regular basis. Vital signs (VS) are: 150/90, 124 irregular, 20,
100.2 ° F (37.9 ° C). Admission assessment findings are: height 5 ft,
8 in; weight 132 lb; appears anxious and restless; loud heart
sounds; 1+ pitting edema noted in bilateral lower extremities;
diminished breath sounds
with fine crackles in the posterior bases. K.B. begins to cry when he
tells you he recently lost his wife; you notice someone has punched
several more holes in his belt so he could tighten it.
Laboratory Values
Hemoglobin (Hgb) 11.8
g/dL Hematocrit (Hct)
36%
Erythrocyte sedimentation rate (ESR) 48
mm/hr Sodium 141 mmol/L
Potassium 4.7 mmol/L
Chloride 101 mmol/L
Blood urea nitrogen (BUN) 33
mg/dL Creatinine 1.9 mg/dL
Free thyroxine (T4) 14.0
ng/dL Triiodothyronine (T3)
230 ng/dL
[AUTHOR] 1
, 1. Which of K.B.'s assessment findings represent
manifestations of hypermetabolism? Fatigue, sudden weight
loss, tachycardia, irregular heart rate, nervousness, anxiety
2. Interpret K.B.'s laboratory results. Elevated ESR, BUN,
Creatinine, T4and T3
3. You go to assess K.B. What additional data do you need to
obtain because he has Graves’disease? Assess for any tremors, any
weight loss, which medications he is currently taking, Check eyes for
exophthalmos, sweating, muscle weakness, depression, double vision
[AUTHOR] 2
