Hyperthyroidism

A 28-year-old man with newly diagnosed Graves' disease is counseled about treatment options. His physician discusses antithyroid drugs, radioactive iodine, and thyroidectomy. Which of the following statements about the management of Graves' disease is NOT correct?

A 32-year-old woman presents with palpitations, tremor, and heat intolerance for 3 weeks. Physical examination reveals a diffuse goiter, tachycardia (HR 110/min), and warm skin. TSH is suppressed at <0.01 mIU/L. What is the investigation of choice to confirm the diagnosis of Graves' disease?

In Graves' disease, which immunoglobulin subclass is responsible for TSH receptor stimulation and the induction of exophthalmos?

A 34-year-old woman from Mumbai presents with a 3-month history of palpitations, tremor, and heat intolerance. She reports recent weight loss despite good appetite. On examination, she has a diffuse goitre, exophthalmos, and pretibial myxoedema. TSH is <0.01 mIU/L, free T4 is 28 pg/mL (normal 7.5–21), and free T3 is 8.5 pg/mL (normal 2.3–4.2). TPO antibodies are positive. What is the most appropriate initial pharmacological management?

A 28-year-old woman presents to the emergency department with severe agitation, high fever (39.5°C), tachycardia (140/min), and altered mental status. She has a known history of Graves' disease diagnosed 2 months ago but defaulted on treatment. On examination, she has a tender, enlarged thyroid and proximal muscle weakness. Free T4 is 35 pg/mL (normal 7.5–21), free T3 is 12 pg/mL (normal 2.3–4.2), and TSH is <0.01 mIU/L. What is the most appropriate immediate management?