AA is 39 year old Bangladesh poor female admitted to Dacha hospital in 22l3l2005 with sign of hyperthyroidism the physician decide for throidectomy because no benefit from past medication by thioamides drugs . Lab test high T3, T4, FT3I and FT4I , CBC normal

1- what the symptoms of hyperthyroidism in this patient
2- what the sign and laboratory finding in AA

3- what are the pertinent signs found in AA indicating Grave’s disease

After one week AA subtotal thyroidectomy was performed. 48 Hr after surgery her serum calcium was 1.8 mmol/L (very low)
4- why is her serum calcium low after subtotal thyroidectomy?

•&νβσπ;The physician describe for her Vitamin D 150,000 IU daily and calcium carbonate 1 gm QDS was given. two month later, she experiences symptoms of hypercalcemia with a serum calcium of 3.5 mmol/L and a serum PO4 of 0.6 mmol/L

5- what are the symptoms of hypercalcemia? why does she have hypercalcemia

•&νβσπ;After 2 years (2007) her hormone disturbance due the dysfunction of thyroid gland and she have SOB and cold intolerance and weakness. her eyes become worse, with diplopia, blurred vision, chemosis and marked protopsis. Her TT4 showed 4 mcg/dl, RT3U 20 %

6- regarding the above signs what type of disease patient have?

7- what the best treatment for above patient?

•&νβσπ;After 1 year(2008) her hormone still disturbance. she came into the out patient clinic with sign of Cushing syndrome. Her Lab indicate high level of cortisone

8- what the mean causes hormone disturbance (Cushing syndrome)

9- what is the sign of Cushing syndrome?

10- enumerate the diagnostic test for Cushing syndrome?

11- enumerate the most common hormones cause Cushing syndrome?

•&νβσπ;The physician prescribe for her Cyproheptadine for Cushing syndrome

12- what you think it is suitable treatment for the above patient ? if suitable or not suitable give your comment

13- what is the most side effect for the above drugs?

•&νβσπ;After 1 year (2009) the patient came into the out patient clinic with Bad condition, with sign of low cortisone due to the lab test (Low serum cortisone)

14- what you think the disease for above patient ?

15- what is the most etiology for above disease?

16- enumerate the suitable diagnostic test for above patient?

17- what is the suitable Lab test for disease if you are mention the disease ?

•&νβσπ;The physician prescribe for AA Cortisne 20 mg/d
18- did you think treatment suitable for above patient? if suitable or not suitable give your comment

•&νβσπ;In 2010 her social situation become worse because she is very poor. most her food from residue food of some traditional restaurant. she cannot pay bill for her medication.
•&νβσπ;1n 2011 she came to hospital with jaundice and dark urine, The Lab test indicate abnormal of liver function test and protein in urine and high ammonia

19- what you think the above patient

20- what the main signs for above if you think she have liver disease?

•&νβσπ;The physician prescribe for her high adequate nutrition intake 2500 cal per day and multivitamin tablet TID

21- did you think the above medication suitable or not? give your comment?

•&νβσπ;After 2 months her sun brought her to hospital but she is unconsciousness. she have sign of edema on lower and upper part of her body and asciates.

22- what the problems for above patient?

23- why her condition become worse?

24- why she become unconsciousness?

25- why she got edema and asciates?

•&νβσπ;After 3 days when she stay in intensive care unit in hospital she pass away (die)

26- what the most common cause death for the above patient?