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C.R., a 27-year-old woman, has a 3-month history of intermittent heat intolerance, sweats, tremor, and severe muscle weakness, which has limited her ability to climb

C.R., a 27-year-old woman, has a 3-month history of intermittent heat intolerance, sweats, tremor, and severe muscle weakness, which has limited her ability to climb stairs. Her weight has increased because of increased appetite. She is also bothered by the pounding of her heart and some minor difficulty in swallowing. There is a family history of thyroid disease, but she denies taking any thyroid medications or any history of radiation to her neck. C.R. previously received iodide drops with symptomatic improvement but her disease recurred despite its continued administration. Her other medical problems include type 2 diabetes controlled by diet, and osteoarthritis treated with aspirin 650 mg orally (PO) every 4 hours. She has a history of noncompliance with her clinic visits. Pertinent physical findings include a blood pressure of 180/90 mm Hg, a pulse of 110 beats/minute, hyperreflexia, lid lag, and a diffusely enlarged thyroid gland that is about four times normal (about 100 g). Laboratory data include the following: TT4, 6 mcg/dL (normal, 4.8–10.4) FT4, 3.9 ng/dL (normal, 0.7–1.9) TSH, <01 microunits/mL (normal, 0.4–4.0) TRAb, + Fasting blood glucose, 350 mg/dL (normal, <100mg/dL) 



1. What would be the best treatment for this patient? Consider pharmacologic and/or non-pharmacologic treatments. Answer in 3-5 sentences only.


2. 

In relation to your treatment recommendation, are there any disease-disease or drug-disease interactions present? If yes, identify.



3. Provide 3 patient counselling points for the patient in order of significance.

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