Hypertensive,nonDM, tremor+, anxious look, eyeball stareing appearance, TSH less than 0.01 ui. with thyroid gland rubbery swelling. Dx, Line of investment,Rx.

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T3.T4 estimation?

Thyrotoxicosis. USG thyroid. Diffuse/nodular. Technicium scanning. h Type of thyroid uptake.

Thyrotoxicosis. Start T. Neomercazole 5mg tds,T. Propanalol 40mg OD

Throtoxicosis Advise T3,T4,Tsh levels Antithrroid antibodies Usg thyroid Consider beta blockers and carbimazole

Toxic nodular goiter.... TSH profile... Thyonamides to start... FNAC but with close monitoring considering thyroid strom... If patient is not willing for Sx anti thyroid drug... If responds well and good... If not then Radio Iodine therapy....as she is old lady...so long term chance of carcinoma is less due to radiation...

In case of thyrotoxicosis don't try an fnac....patient might have severe bleeding or storm...reduce the toxic symptoms and go for pathological diagnosis and proceed accordingly...

It is a case of toxic goitre with clinical features s/o Thyrotoxicosis Advice T3, T4 , FNAC of swelling, If needed may go for RAIU scan too , to rule out malignancy. USG for the thyroid swelling can be adviced. Then plan for thyroidectomy . Till then treat the symptoms with tab Neomercazole 5 mg @ 8hrly which can be increased from 15- 40 mg / day in divided doses; tab propranolol 40 mg OD ,whose dose may be increased if anxiety ,tremors are not controlled. As propranolol may be given upto dosage 40 mg BD / TID.

Start Tab Methimazole 60mg in four divided doses per day

Total Thyroidectomy after making patient euthyroid
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Toxic goitre

Goiter
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