№
| Rating steps
|
1.
| Collection of complaints and anamnesis
| Carried regularly and systematically
|
2.
| Refinement asked additional questions due to differential diagnosis.
| Asked questions were on dieses symptoms
|
3.
| Physical examination (skin, mucous membranes, DUI and etc.)
| Objective examination of height and weight, skin and mucous membrane. Normasthenic. Decreasing of subcutaneous fat skin thickness
|
4.
| Examination of the cardiovascular system.
| Find out boundaries of the relative dullness of the heart and apex of the heart. Make auscultation of the heart in series.
|
5.
| Measurement of blood pressure, pulse rate determination
| According to the rules of pulse measuring and blood pressure.
|
6.
| Palpation of the thyroid gland
| Palpation of the thyroid gland was made in series.
|
7.
| Definitions of eye symptoms.
| Identified the symptoms of Graefe, Kocher, Mobius
|
8.
| Preparation of predicted diagnosis and its justification.
| Exposed preliminary diagnosis of complaints, anamnesis and physical examination.
|
9.
| Preparation of differential diagnosis
| In order to avoid neurocirculatory dystonia: Lack of eye symptoms, progressive weight loss, tachycardia at rest and increased thyroid gland. Antibody to TSH receptors, free T4 and T3. Toxic thyroid adenoma: lack of eye symptoms, pretibial myxedem
|
10.
| Laboratory research plan assignment.
| GBA,UA, BBA: glucose, total protein, cholesterol, potassium, calcium, bilirubin.
|
11.
| Interpretation of hormonal study (TSH, T3, T4 in the blood)
| Decrease levels of TSH, raising of unbound T3 and unbound T4
|
12.
| Interpretation of biochemical analysis of blood
| Insignificant hypercholesterolemia, hyppotassiumemia.
|
13.
| Assignment of instrumental research plan.
| Thyroid gland ultrasound, ECG, echocardiography.
|
14.
| Thyroid gland ultrasound interpretation
| The thyroid gland is diffusely enlarged, hypoechoic. The total volume is 36 cm3.
|
15.
| ECG interpretation
| Sinus tachycardia, pulse 110, EHO is shifted to the left. Left ventricular hypertrophy.
|
16.
| Eye ultrasound interpretation
| The acute phase of endocrine ophthalmopathy, moderate. Muscle hypertrophy. Myopia 1 degree
|
17.
| Final diagnosis principles
| Put diagnosis on the basis complaints, medical history, physical examination, decreased TSH, raising unbound T3 and unbound T4, a little amount of hypocholesterolemia, hypokalemia, ultrasound of the thyroid gland; The thyroid gland is diffusely enlarged, hypoechoic. The total volume is 36 cm3; US eyes; The acute phase of endocrine ophthalmopathy, moderate. Muscle hypertrophy. Myopia 1 degree, ECG; Sinus tachycardia, EHO is shifted to the left. Left ventricular hypertrophy. The syndrome of hyperthyroidism, GV (Graves' disease), moderate hyperthyroidism, decompensated. Endocrine ophthalmopathy.
|
18.
| disease treatment principles
-tireostathicks
-symptomatic treatment
| 1. Drug therapy: tireostatheic(tirozol, Mercazolilum)
2. Treatment І131
3. Surgery
4. Symptomatic treatment (beta blocker, sorbent, sedatives)
|
19.
| Maximum benevolent attitude to make patient feel comfort
| Maximum friendly attitude and the patient calmed down.
|