Urgent work
Graves Disease
Cory Neal, Caroline Pic, Kadhem Alduaybil
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Case Study A 20-year old female softball player comes to you because she is generally not feeling well. At first she thought she had a bug, because she was just not feeling well, but now she has noticed that she is anxious all the time, irritable, and she notes that she is having heart palpitations. She also notes a weight loss over the last few weeks, despite eating normally.
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History Questions History of other illnesses? Family history of immune system disorder, but she cannot remember the exact illness.
When did you first notice your symptoms? Over the last couple of weeks, something just doesn’t feel right.
Have you been vomiting since you have felt "weird"? No but have noticed a weight loss or 15-20lbs
Is there a history of anxiety in your family? No
Have you been exercising more excessively? No been exercise about the same but have notice I have increased perspiration
What have you been eating? Normal meals are nothing out of the ordinary.
Are you having any chest pain besides the palpitations? No chest pains but my hands and fingers are shaky.
Have you had a feeling of added stress in: sports, school work or personal life? Not really but this has me worried
Is there a chance you could be pregnant? No
Are you having any abnormalities or issues with your menstrual cycle? When was your last cycle? It has been really irregular , may 7 weeks
ago.
Are you noticing any puffiness to your eyes? Yes they feel inflamed
Do you feel as if you are more sensitive to heat and feel as if your body is overheating? Yes
Are you feeling more fatigued or muscle weakness lately? More than normal? Yes but was unsure if that had to do with my difficulty sleeping.
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Differential Diagnosis 1. Severe Anxiety Disorder:
a. Why we thought this? Fast heart rate, anxious, irritability, weight loss. b. Why we ruled it out-No trigger or cause of anxious behavior, No family history of SAD, No
paranoia or depression.
2. Parkinson’s Disease: a. Why we thought this? Hand tremors, trouble sleeping. b. Why we ruled it out-No muscular stiffness or rigidity, No balance issues, No impairments to
speech.
3. Graves’s Disease: a. Why we thought this? Protruding eyes, sudden weight loss, pressure in eyes, increased
sweating, increased heart rate. b. Why we chose this-The protruding eyes, increased heart rate, sweating and weight loss
helped point us to a thyroid condition.
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Signs and Symptoms of the patient from the case Signs
● Hands and finger tremors ● Inflamed and puffy eyes ● Enlarged thyroid area - neck is tender and
enlarged = Goiter
● Exophthalmos (protruding eyes)
Symptoms
● Weight loss ● Sensitive to heat and light ● Increased perspiration ● Irregular menstruation ● Difficulty sleeping ● Heart palpitations and rapid HR ● Pressure in eyes ● Anxious/ irritable ● Fatigue/ tired
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Signs and Symptoms of Graves Disease Signs
● Hand and finger tremors ● Goiter or enlarged thyroid area ● Bulging eyes or exophthalmos ● Thick or red skin on top of feet or shins ● Puffy eyes
Symptoms
● Anxiety/irritability ● Heat sensitivity with increased perspiration ● Weight loss ● Menstrual cycle irregularities ● Frequent bowel movements ● Fatigue ● Rapid or irregular HR with heart
palpitations
● Light sensitivity or double vision
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Risk Factors Some things that can predispose someone to Graves Disease is:
● Family history ● Gender - women are more likely to get ● Age - develops typically in people under 40 years old ● Have other autoimmune diseases - ex: type 1 diabetes ● Pregnancy ● Smoking ● Emotional or physical stress
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How to diagnose ● Physical exam of eyes/thyroid area/ tremors ● Blood tests(what to look for in results):
○ Low TSH levels ○ Antibodies in the blood ○ Uptake of radioactive iodine ○ Elevated T3 and T4 levels
● Imaging using MRI, CT scan, possible xray ● Ultrasound to see if thyroid is enlarged
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Treatment ● Radioactive iodine ● Prescription of antithyroid drugs or beta blockers ● Surgical removal of the thyroid gland ● Intake of beta-blockers
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Prognosis
● Diagnosis: Graves Disease ● Prognosis:
○ Try your best to eat well ○ Exercise - effects of the treatment may result in weight gain ○ Ease stress or reduce it ○ Patients that are completing treatment should be aware of developing hypothyroidism ○ Possibility of getting eye disease but as long as it is well managed, there will be a reduction of
symptoms
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Effects on Athletics & RTP ● Once the athlete has gone to a doctor and has the proper
medications/treatments to maintain the disease the athlete may RTP upon clearance from their PCP or Specialist. The athlete should ease back into play based on how they feel and what they feel as if they can do. Acclimation to their new medications mixed with endurance activities, increased body temp, environmental factors should take place over a few weeks.
● If not properly monitored the athlete can have hydration issues, muscle weakness, decreased energy that arise. Athletic trainers, the athlete and coaches should be aware of what to look for and have open lines of communication with each other in order to ensure the athletes safety.
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In Conclusion... ● Graves Disease is classified as a form of hyperthyroidism ● Hyperthyroidism occurs when the levels of
○ T3(triiodothyronine) and ○ T4(thyroxine) are increased in the body
● It occurs due to a malfunction in the body’s disease-fighting immune system ● One needs imaging and or ultrasound in order to diagnose it ● The prognosis is pretty good if the patients follow through with maintaining
their exercise, dieting as well as taking the prescribed medications and or undergo surgery
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Question for the Class... 1. Do you know anyone or have worked with anyone that has a thyroid condition? 2. How would you help a client/patient maintain a healthy diet and exercise? 3. What kind of risks would athletes have if they had this condition? 4. What kind of accommodations/recommendations would you make for an
athlete?
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References Book Citation: Hubert, R. J., & VanMeter, K. (2018). Gould's pathophysiology for the health professions (6th ed.). St. Louis, MO: Elsevier. Online Resources:
(1) Mayo clinic. (2020). Graves’ disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240
(2) Anne Arundel Medical Group.. (2020). Retrieved from https://osmc.net/services-specialties/hw-view.php?DOCHWID=hw149039
(3) From Graves Disease To Finishing The Kona Ironman - Graves', HYPERthyroidism, Thyroid. (2019, September 24). Retrieved from https://thyroidnation.com/graves-disease-finishing-ironman/
(4) Fante, R. G. (2020). Graves Disease Treatments in Denver: Thyroid Disease in Boulder, CO. Retrieved from https://www.drfante.com/services/reconstructive-surgery/thyroid-related-eye-problems-graves-disease/
Picture Links: https://www.drfante.com/services/reconstructive-surgery/thyroid-related-eye-problems-graves-disease/ https://www.healthcentral.com/article/Antithyroid-drugs-for-graves-disease-and-hyperthyroidism http://sjccfthynet.blogspot.com/2012/02/radioactive-iodine-treatment-basics.html https://thyroidnation.com/graves-disease-finishing-ironman/ https://www.healthline.com/health/blood-tests