Case 397

Medical history

71-years-old male, former smoker, with a history of iodine radioablation in 2012 after being diagnosed with Graves'disease when he was 62-years-old. In follow-up at the endocrinology service, he complains of itching, burning and watery eyes. He has a glycated hemoglobin measurement of 6.1%. CT scan of the orbits was requested.

Analyzing the patient's images and data, it can be concluded that the most likely cause of the ocular signs and symptoms is:

Test question

(Medical Residence 2015 - Hospital Universitário Onofre Lopes - UFRN)

24-year-old woman with a history of bronchial asthma and celiac disease, using beclomethasone and formoterol via inhalation and a gluten-free diet, seeks medical attention due to complaints of palpitations, extremity tremors, insomnia and loss of 8 kg in the last 3 months. On physical examination, it shows: ACV - RCR without murmurs; FC: 118 bpm; PA: 140 x 70 mmHg; fine upper extremity tremors; exacerbated Achilles and patellar reflexes; important conjunctival hyperemia; bilateral chemosis and proptosis. Thyroid palpation was performed, with increased dimensions, fibroelastic consistency, without palpable nodules, without murmurs. In addition, the patient is eupneic, stained and oriented. The results of his laboratory tests were: TSH: <0.05 (VR: 0.4-4.0); free T4: 4.2 (VR: 0.7-1.8); T3T: 311 (VR: 110-260).

For this patient, the appropriate approach is to start treatment with:

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