Medical records

The patient Keisey kahlani, a 39 year old female, was admitted to the hospital for more than 10 days due to palpitations, fatigue, and dizziness. 
There is no protrusion in the eyeballs, the eyeballs move freely, the thyroid gland is of grade II, enlarged, tough, and movable. 
No obvious nodules are palpable, and no vascular murmurs are heard. 
Electrocardiogram: Sinus tachycardia with left axis deviation. 
Liver function ALT 96.3IU/L TB and DB are normal. 
FT3 30.04pmol/l, TSAB (-) TSH0.98uIu/ML, T4 162.563ng/ml, T3 5.570ng/ml.

Preliminary diagnosis: 
Graves disease with liver damage
Treatment plan: 
  1. PTU 600mg is preferred for inhibiting thyroid hormone synthesis, which can be administered orally or through a gastric tube, followed by 200mg, once every 8 hours. Other anti-thyroid drugs should be used at equivalent doses. Reduce to regular dosage after symptom relief.  
  2. Inhibit the release of synthesized thyroid hormones into the blood with high-dose iodine and inhibit the binding of T3 to its receptors. Administer iodine solution 1 hour after taking PTU, including 5 drops of compound iodine solution, every 6 hours. Alternatively, 1.0g of sodium iodide can be added to 500mL of glucose injection for intravenous infusion, with 1-3 grams available for the first 24 hours. As the treatment improves, the dosage gradually decreases, and the course of treatment is generally 3-7 days.  Individuals who are intolerant to iodine can take lithium carbonate 0.5-1.5g/d for a short period of time, orally in batches. 
  3. Glucocorticoids can enhance stress response and inhibit the conversion of T4 to T3. Hydrocortisone 100mg is administered intravenously and repeated every 6-8 hours thereafter. Reduce the catecholamine effect, optional β- Adrenergic receptor blockers: Take 20-40mg of propranolol orally every 6-8 hours, or slowly inject 1mg intravenously after dilution. Repeat 3-5 times as needed. Alternatively, reserpine can be used. 
  4. Support symptomatic treatment such as oxygen inhalation and physical cooling [avoid using aspirin as it can combine with TBG to release free thyroid hormones]. If necessary, use sedatives or artificial hibernation, fight infections, correct shock, maintain water electrolyte balance, supplement sufficient calories and vitamins, and monitor heart and kidney function.