Detailed Treatment Process
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Female, 26 years old, with a 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 with recent self-discontinuation of medication. The patient was brought to the emergency department by ambulance after syncope. Electrocardiogram showed paroxysmal supraventricular tachycardia. The emergency physician recommended 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 ECG 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 unclear) 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, half tablet chewed twice. Advise rest for one day.
Cardiology recommended hospital admission for radiofrequency ablation. The patient agreed to admission but requested thyroid function tests before the procedure. This testing was initiated at the patient’s own request. Cardiology had not ordered thyroid function tests proactively before the patient asked. (See below.) The thyroid function results showed T3 = 6.87, T4 = 242, FT3 = 24.64, FT4 = 57.74, all markedly elevated. This indicated that the patient was in a hyperthyroid state at the time. ********* Laboratory 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 results became available, a gurney from the operating room was brought to the patient’s bedside. At this point, the patient declined the radiofrequency ablation procedure. She was discharged and resumed her anti-hyperthyroid medication.