CHART NOTE
A 26-year-old referred for Graves disease. Patient first found to be hyperthyroid shortly after she became pregnant, was placed on PTU 350 mg taken in divided doses until 1 week prior to delivery. She has all the classical symptoms of hyperthyroidism, including tremors, soft frequent stool, being hot, insomnia, weakness in her legs, and exophthalmos.
On physical examination, extraocular movements were fairly full except that she could not converge. Examination of her thyroid revealed the gland to be at least 2 times the normal size with classical, rather mushy, soft feeling of hyperthyroidism. No nodules were noted. Examination of her skin revealed normal amounts of forearm hair but extension of hair on the backs of her hands. She was also beginning to get hair formed on the upper lip at the corners of her mouth. There is no periareolar hair; however, she has a well-developed male escutcheon.
I talked with the patient about this, and when she has been euthyroid for a bit, we will consider measuring her androgen level. Patient was asked to discontinue PTU and obtain a T4 and T3. Appointment was made with Nuclear Medicine for her to have an uptake scan and therapy next week. I decided to investigate the androgen problem at a later date when we will not have the effect of thyroxine on liver metabolism.
FOOTNOTE
Line 7. The article A was inserted before 26 to avoid beginning the sentence with a numeral.
Line 27. Alternative: Nuclear medicine.
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