A 45-year-old man suffered from weight loss, palpitations, tremor, anxiety and sweating, plus eyelid retraction and orbital and ocular inflammation. Blood tests showed increased levels of free and...

A 45-year-old man suffered from weight loss, palpitations, tremor, anxiety and sweating, plus eyelid retraction and orbital and ocular inflammation. Blood tests showed increased levels of free and bound T3 and T4 and low levels of TSH. A diagnosis of Graves’ thyrotoxicosis was made. An electrocardiogram showed atrial fibrillation.

1. What is Graves’ disease, and why are T3/T4 levels high and TSH levels low?

2. What drug should be given to control the hyperthyroidism, and what other drugs might help control the symptoms in this man?

3. With treatment, he became euthyroid, but relapsed in the following year. A decision was made to treat him with 131I. What treatment should be given before administering the 131I, and what are the reasons for this?