Subjective

(weight loss, heat intolerance)

Family history is significant for thyroid disease in both
grandmothers (both on thyroid replacement therapies).
Objective
Free T4, T3, TSH, anti-TSH receptor antibodies, antithyroglobulin
and antithyroid peroxidase antibodies.
Free thyroxine (FT4) 2.87 ng/dL (Prepubertal 0.73-1.77 Pubertal/Adult
0.73-1.84) too hight
Total triiodothyronine pediatric (T3) 374.00 ng/dL (123-211)
Thyroid-stimulating hormone (TSH) <0.018 uU/ml
Thyroxine (T4) 18.2 ug/dL (5.0-12.0)
Antithyroglobulin antibodies >3000 IU/ml (Negative <60 IU/mL
Equivocal 60-100IU/mL Positive >100 IU/mL)
Antithyroid peroxidase antibodies 2667 IU/mL (<60) Anti-TSH receptor
antibodies 69.6 % Inhibit. (<=16.0 Unit: %)
hyperthyroidism with thyrotoxicosis
assesment

Untuk untuk thyrotoxicosis sesuai dengan

She has been given some brief course of Prednisone as well, and Atenolol 50 mg
twice a day was also started.

methimazole for Graves Disease ( hypertyroidism with thyrotoxicosis)

10-20 mg/day PO; after euthyroidism is achieved, reduce dosage by 50% and
administer for 12-18 months
Untuk keracunan thyrotoxicosis

20-30 mg q6-12hr for short term, then reduce dosage to

maintenance (5-15 mg/day) or reduce frequency to q12hr or q24hr
bekerja dengan menghambat sistesis dari hormon tiroid dengan
memblok oxidasi dari iodine di dalam kelenjar tiroid sehingga tidak
terbentuknya sintesis tiroitoksin t4 dan t3
Inhibits synthesis of thyroid hormone by blocking oxidation of iodine
in thyroid gland; blocks synthesis of thyroxine (T4) and
triiodothyronine (T3)
By medscape
Di pilih berdasarkan

Ata, 2016.
After 2 weeks she developed severe adverse reaction to it with

significant joint pain and swelling over her upper and lower
extremities with hives berarti dia alergi obat methimazole

Diphenhydramine(Benadryl) anti alergi

Ibuprofen (advil) analgesik
Membaik setelah di beri obat tersebut setelah beberapa hari
Prednisone as well, and Atenolol 50 mg twice a day was also
started
the patient was considered to have radioiodine ablation RAI of her
thyroid next day and for that she underwent a thyroid imaging
with uptake showing enlarged thyroid gland
she was stable on Atenolol 50 mg twice a day

At her next follow-up appointment in 2 weeks her thyroid functions tests lab values
were as follows:
T4, Free, >12.00 ng/dl (Prepubertal 0.73-1.77 Pubertal/Adult 0.73-1.84)
T3, 1173.00 ng/dL (123-211 ng/dL)
TSH, <0.018 uIU/mL

Monitoring

Jadi harus adanya monitoring atau assasment 4 minggu setelah

initiation terapi

Recomendasi
Karena tidak dapat di jalankan pengobatan secara obat
maka di rekomendasikan untuk i terapy atau oprasi