Detailed Treatment Process
Female, 26 years old, history of hyperthyroidism. Laboratory report (while on medication) Test item Result Reference range Free T3 3.78 (3.1-6.5 pmol/L) Free T4 15.20 (9-23.2 pmol/L) Thyroid-stimulating hormone 1.89 (0.25-4 uIU/ml) Reverse T3 0.72 (0.54-1.46 nmol/L) Thyroid peroxidase antibody 22.99 (5.00-34.00 IU/mL) Thyrotropin receptor antibody 1.10 (0.30-1.75 IU/L) Thyroglobulin antibody 124.50↑ (10.00-115.00 IU/mL)
* History of hyperthyroidism, recently self-discontinued medication. Sent to the emergency department by ambulance due to syncope. Electrocardiogram showed paroxysmal supraventricular tachycardia. Emergency department advised transfer to cardiology for follow-up.
* Electrocardiogram report Heart rate: 178 bpm P-R interval: / ms QRS duration: 58 ms QRS axis: 50 ° Q-T interval: 266 ms QTc: 458 ms R(V₅) +S(V₁): 2.17 mv Electrocardiogram diagnosis: 1. Paroxysmal supraventricular tachycardia; 2. ST segment depression; 3. T wave changes Speed: 25 mm/sec Gain: 10 mm/mV Report date: August 25
Medical record (handwritten scan, some characters may be misidentified) August 25 Chief complaint: Palpitations for half an hour. Physical examination: Alert, HR 180 beats/min, regular rhythm, Bp 130/75 mmHg. ℞: NS 20 mg iv Verapamil 5-8 mg iv (18:27) Repeat ECG: Sinus tachycardia Recommendation: Cardiology follow-up Metoprolol 47.5 mg 1/2 tablet, chewed, twice. Advise rest for one day.
* Cardiology recommended hospitalization for radiofrequency ablation treatment. The patient accepted the hospitalization recommendation but requested thyroid function tests before the radiofrequency ablation. This test was actively requested by the patient. The cardiology department did not proactively order thyroid function tests for the patient. At least before the patient requested the test, cardiology had not actively tested the patient's thyroid function. (See below) The thyroid function test results showed T3=6.87, T4=242, FT3=24.64, FT4=57.74, all abnormally elevated. This indicates that the patient was in a hyperthyroid state at that time. ********* Laboratory Medicine Department Test Report T3 6.87 ↑ (1.3-3.1 nmol/L) T4 242.00 ↑ (62-164 nmol/L) FT3 24.64 ↑ (3.1-6.8 pmol/L) FT4 57.74 ↑ (12-22 pmol/L) High-sensitivity TSH 0.01 ↓ (0.27-4.2 mIU/L)
* After the thyroid function test results came back, the operating room stretcher was wheeled to the patient's bedside. At this point, the patient expressed unwillingness to undergo the radiofrequency ablation procedure. She was discharged and resumed her anti-hyperthyroidism medication.