Hyperthyroidism

11/01/2024 Dear Dr. Smith, Thank you for referring Jane Doe. She was assessed in clinic today. As you know, Jane is a 45-year-old woman referred for hyperthyroidism. PAST MEDICAL HISTORY: - Hypertension - Type 2 Diabetes MEDICATIONS: - Metformin - Lisinopril ALLERGIES: - Penicillin SOCIAL HISTORY: Jane is a non-smoker and works as a school teacher. She lives with her husband and two children. FAMILY HISTORY: Her mother had a history of hyperthyroidism, and her father has hypertension. HISTORY OF PRESENTING ILLNESS: Jane has been experiencing symptoms of hyperthyroidism for the past three months, including weight loss, palpitations, and increased sweating. She reports feeling anxious and has noticed a tremor in her hands. These symptoms have gradually worsened over time. PHYSICAL EXAMINATION: Height 165 cm, weight 60 kg, blood pressure 130/85. Normal S1 S2, no extra heart sounds, no murmur. Lungs were clear. Thyroid was visible on inspection. Thyroid was enlarged on palpation. Some nodules were appreciated. Thyroid bruit was present. There was a tremor on outstretched hands. Neck was not tender. No head or neck lymphadenopathy. Full EOM. There was lid lag. No scleral injection. No proptosis. ASSESSMENT AND PLAN: Jane's clinical presentation and examination findings are consistent with hyperthyroidism, likely due to Graves' disease given the presence of thyroid bruit and family history. We will initiate treatment with methimazole and monitor her thyroid function tests closely. Beta-blockers will be prescribed to manage her palpitations and tremor. Follow-up in four weeks is recommended to assess her response to treatment and adjust medications as necessary. Patient education on the importance of medication adherence and monitoring symptoms was provided. Thank you for involving me in her care. Sincerely, Dr. Ken Smith