Reference no: EM133383399

A 35-year-old nurse complained of nervousness, weakness, and palpitations with exertion for the past 6 months. Recently, she noticed excessive sweating and wanted to sleep with fewer blankets than her husband. She had maintained a normal weight of 120 pounds but was eating twice as much as she did 1 year ago. Menstrual periods have been regular but there was less bleeding.

Physical/Assessment examination: Pulse was 102/minute and BP was 130/60. She appeared anxious, with a smooth, warm, and moist skin, a fine tremor, a bounding cardiac apical pulse, and she couldn't rise from a deep knee bend without aid. Her thyroid contained 3 nodules, 2 on the right and one on the left. Her eyes were not prominent (proptotic or exophthalmos) and she had no focal skin thickening.
Laboratory studies: Serum T4=15.6 ug/dl and serum T3=250 ng/dl (N=80-160).

Lab Normal Range: Lab Results
WBC                       8,200
Hemoglobin            13
Hematocrit             41
RBC                       4.2
Platelets                    230,000
T3                          8.9
T4                         12.8
Free                       T4 1.99

1. What do you anticipate the diagnosis for this patient to be? Are additional diagnostic tests necessary to define the level of thyroid function and if so which one(s)?

2. What are the symptoms that made you consider that diagnosis?

3. What physical findings supported the diagnosis?

4. Which lab data supported the diagnosis?

5. What are the treatment options?

Mrs. Hopeful has decided to try Methimazole before considering a thyroidectomy.

6. What patient teaching would you include before Mrs. Hopeful starts this medication?

Mrs. Hopeful's condition is not improving as the physician had hoped. They have consulted and discussed further options. After careful consideration Mrs. Hopeful has decided to have a thyroidectomy. You will be the nurse caring for Mrs. Hopeful after surgery.

7. What potential complications are you monitor for immediately after surgery? How will you assess for these complications? What do you need at the bedside incase these complications occur?