32F Pregnancy associated Graves Disease Telangana PaJR
[28-03-2025 13:02] PPM 1: Add clinical images @~PPM3 @~PPM4
[28-03-2025 13:07] PPM 1: Once we have shared all her data including events in her case report and
discussed all her requirements here (Varun had some interesting questions, please add him here
@~PPM4 we can then add the patient too to share her daily input output
[28-03-2025 13:08] PPM 1: @CR may need to YouTube all the video data and share the links in the
case report
[28-03-2025 13:09] PPM 1: Share your questions here @PPM5
[28-03-2025 13:09] PPM 5: Kk sir
[28-03-2025 13:10] PPM 1: This has come out well. Can edit to shorten the frame @CR such that her
chin and earrings are not visible to remove as much potential identifiers.
[28-03-2025 13:11] PPM 3: I'll do it and send sir
[28-03-2025 13:11] PPM 1: The above documents will need to be deleted after cropping identifiers and
resharing them here
https://youtu.be/wmepa-S4n48?si=Da20GP4LhdqVvBvX
[28-03-2025 13:14] PPM 5: Sir she asked for while taking treatment which food should be avoided
[28-03-2025 13:15] PPM 1: @~PPM4 will search for this answer
After @Meta AI tells us about if there's any particular foods to avoid in Graves disease.
Graves' disease is an autoimmune disorder that affects the thyroid gland, causing hyperthyroidism. While there isn't a specific "Graves' disease diet," some foods may exacerbate symptoms or interfere with treatment. Here are some foods to limit or avoid:
# Iodine-rich foods
1. Kelp and other seaweeds: High in iodine, which can worsen hyperthyroidism.
2. Iodized salt: Limit excessive consumption, as it may exacerbate thyroid issues.
# Foods that may interfere with medication
1. Soy products: May interfere with thyroid medication absorption.
2. Fiber-rich foods: While fiber is essential, high amounts may reduce medication absorption. Take medication at least 30 minutes before or after eating fiber-rich foods.
# Foods that may trigger inflammation
1. Gluten: Some people with Graves' disease may have a gluten intolerance, which can trigger inflammation.
2. Processed foods: Limit foods high in sugar, salt, and unhealthy fats, as they can promote inflammation.
# Other considerations
1. Caffeine: May worsen anxiety, palpitations, and insomnia associated with hyperthyroidism. Limit or avoid caffeine.
2. Alcohol: May interact with thyroid medication and worsen symptoms.
# Focus on a balanced diet
While avoiding certain foods, focus on a nutrient-rich diet with:
- Fresh fruits and vegetables
- Whole grains
- Lean proteins
- Healthy fats
- Calcium-rich foods (to support bone health)
Remember, everyone's nutritional needs and health goals are different. Consult with your healthcare provider or a registered dietitian to develop a personalized diet plan that suits your needs with Graves' disease.
[28-03-2025 13:16] PPM 5: And there is any dietary associated treatment.
[28-03-2025 13:16] PPM 1: @Meta AI please share any randomized controlled trial evidence to support
your dietary recommendation for Graves disease along with valid searchable references
[28-03-2025 13:16] Meta AI: While there isn't a specific "Graves' disease diet," some foods may
exacerbate symptoms or interfere with treatment. Here are some evidence-based dietary
recommendations:
- Iodine-rich foods: Limit or avoid foods high in iodine, such as kelp and seaweed, as they can worsen hyperthyroidism.¹
- Soy products: Avoid soy products, as they may interfere with thyroid medication absorption.
- Fiber-rich foods: While fiber is essential, high amounts may reduce medication absorption. Take medication at least 30 minutes before or after eating fiber-rich foods.
- Processed foods: Limit foods high in sugar, salt, and unhealthy fats, as they can promote inflammation.
- Ginger: Some studies suggest that ginger supplementation may alleviate symptoms of hypothyroidism, but more research is needed.
- Selenium: Selenium supplements may have a beneficial effect on thyroid eye disease, but more research is needed to confirm its effectiveness for Graves' disease.
- Zinc: Zinc supplementation may improve outcomes in people with hypothyroidism, but more research is needed.
Some studies have investigated the effects of dietary interventions on autoimmune thyroid disease. A systematic review and meta-analysis found that dietary interventions may have a beneficial effect on autoimmune thyroid disease, but more research is needed to confirm these findings.²
It's essential to consult with your healthcare provider or a registered dietitian to develop a personalized diet plan that suits your needs with Graves' disease.
[28-03-2025 13:17] Meta AI: https://www.btf-thyroid.org/diets-and-supplements-for-thyroid-disorders
[28-03-2025 13:17] Meta AI: https://www.endocrine-abstracts.org/ea/0070/ea0070aep1106
[28-03-2025 13:17] PPM 1: @Meta AI share the randomized controlled trials listed in that systematic review
[28-03-2025 13:17] Meta AI: The systematic review I mentioned earlier discusses various dietary interventions for autoimmune thyroid disease, including Graves' disease. However, it doesn't explicitly list specific randomized controlled trials (RCTs).¹
That being said, the review does mention that 28 studies were included in the analysis, focusing on different types of dietary supplements and their effectiveness in managing autoimmune thyroid diseases. Some of the interventions mentioned include:
- Selenium supplementation: Improved serum TSH levels and reduced anti-TPO antibody levels.
- Nigella sativa supplementation: Showed improvement in TSH and FT4 levels.
- Myo-inositol and selenium combination: Revealed improvement in FT4 and Anti-Tg antibody levels.
If you're looking for specific RCTs on dietary interventions for Graves' disease, I recommend searching through databases like PubMed or Web of Science using relevant keywords.
[28-03-2025 13:17] Meta AI: https://www.endocrine-abstracts.org/ea/0070/ea0070aep1106
[28-03-2025 21:06] PPM 4: https://pubmed.ncbi.nlm.nih.gov/36598468/
Sir, this full article suggests that a paleolithic diet can help with autoimmune thyroid disorders,
including Hashimoto’s thyroiditis and Grave’s disease.
This is a short summary of the paper:
P: Female patients diagnosed with autoimmune thyroid disease
I: Prescribing a paleolithic diet to these patients
C: Normal standard of care with medication
O: Improved thyroid homeostasis
By a paleolithic diet, this paper refers to:
“Consumption of lean meats, seafood, fruits, vegetables, roots, small amounts of grains and legumes, nuts and seeds, mushrooms and moss.
Exludes: diary and refined food, processed genetically modified and canned foods and ingredients.”
Some statistically significant findings about how this diet influenced outcomes include:
“Significant improvements were identified in one particular case study including a reduction of TSH by 36.4%, Tg Ab by 47.4%, TPO Ab by 28.9%, and an increase in total T4 (T-T4) by 21.5% and total T3 (T-T3) by 33.3% in just 8 weeks. Four studies showed clinical improvement of both HT and GD Ab and resolution of diagnosis over a 12 week to 24 month period; reduction in TSH and TPO Ab, normalized TSH and Tg Ab, and reduction of TPO Ab, resolution of GD diagnosis via negative TSHR Abs and normalization of T4 and T3, and resolution of HT diagnosis via normalization of TSH, and both Tg and TPO Abs. Arick found an improvement in HT Tg Abs. Manousou et al. stated there were not significant differences in TSH, T4, and T3 between groups, but when they did longitudinal analyses, TSH and FT4 increased in the PD group and they found T3 decreases in the PD group after the first 6 months. Additionally, Abbott et al. found no significant changes in HT thyroid hormones or Abs, but noted a significant improvement in health related quality of life (HRQL) and symptom burden. In total, six of the eight studies (75%) showed considerable improvements in both HT and GD Abs and resolution of both HT and GD diagnoses Results may be associated with the level of compliance from study subjects.”
[28-03-2025 21:18] PPM 1: Let's just closely examine a single such study by mentioning
P: total patients in the study
I: how many consumed what diet in each diet group
C: what was contained in the normal diet group and how many persons in that group?
O: Let's just look at resolution of GD diagnosis and not bother about the biochemical improvement because it's ultimately the clinical improvement that would matter
[28-03-2025 21:19] PPM 4: Okay sir
[28-03-2025 22:03] PPM 4: https://europepmc.org/article/med/31476135
Sir, this was one of the references for this article and I thought it was relevant due to the patient’s age
and a subsequent pregnancy.
P: 34 year old Caucasiam female
I: Dietary changes, oral health interventions, practice of yoga
C: Since this is a case report of a single person, the comparison was her own previous diet, which primarily included salads, seasonal fruits and meat and quinoa.
O: A progressive improvement of symptoms such as palpitations, weight loss, agitation, tearfulness, and glucose dysregulation (frequent snacking, intense appetite in the morning, only feeling energised by meals). The patient’s low grade hair loss continued to persist, however.
Diet consumed was: meat, fish, eggs, nuts and seeds, fruits and vegetables; while removing processed foods, refined carbohydrates, dairy, gluten. This food could be reintroduced later on in small quantities if desired.
The patient also had a successful pregnancy with the exception of the first trimester, where she had a relapse of her disease, but it was then bought under control and she had no further problems.
The baby was born healthy with no signs of neonatal hyperthyroidism either.
[29-03-2025 07:28] PPM 1: Excellent share 👏👏
How to get the full text?
[29-03-2025 07:55] PPM 1: Seeing this today morning, a journal editor and head neuroscience research
lab, PGI, Chandigarh, wants you all to publish this PaJR patient here in his journal!👇
[29/03, 07:34]aa: Like this please consider submitting N of 1 trials to
[29/03, 07:52]cm: We could. One of our medical students actually reviewed this for a similar patient of
ours yesterday!
[29-03-2025 08:16] PPM 1: While this is a nice serendipitous finding about a single case (with it's
obvious scientific limitations), i meant let's look at a single RCT on the interventions for autoimmune
thyroid disease.
We are currently working on a paper with @~RK @~~M @PPM2 that addresses the current limitations of RCTs, as they are compelled to look at single causes and effects due to reductionist nature of scientific study designs that often manages to remove the whole patient context from the problem they are addressing!
Our current paper is proposing a new design that will be able to tie up every data element in an ontology framework driven by case based reasoning engines and make them flow together in a future AI supported whole-o-graphic ecosystem where every part is embedded in and is found to contain the whole especially when one breaks off different fragments from the whole and finds the whole still contained in the individual broken fragments!
Check out the section basics of holography here:
More about case based reasoning here: https://pmc.ncbi.nlm.nih.gov/articles/PMC544898
[29-03-2025 13:14] PPM 4: Sir, I found the pdf of the article on google scholar
[29-03-2025 13:15] PPM 4: I’ve taken her history sir, I’ll share it by tonight here in the group
[29-03-2025 13:18] PPM 4: Yes, sir. While I haven’t found a proper RCT for Grave’s disease yet, I’ve
seen a couple for Hashimoto’s thyroiditis, can I share those findings here as well?
[29-03-2025 14:38] PPM 1: Share it here
[29-03-2025 14:39] PPM 1: Can
[29-03-2025 14:39] PPM 1: One by one
[29-03-2025 16:32] PPM 1: Now let's write up both of our current Graves disease cases in the format
given here. 👏👏
The case report linked here in the description box as well as another graves disease seen a few weeks back already logged here 👇
https://pajrcasereporter.blogspot.com/2025/03/36f-with-graves-disease-diagnosed.html?m=1
And then submit to the editor of jimcr as linked above @~PPM4 @~PPM3 @~~M @~R K
[29-03-2025 16:49] PPM 4: Yes, sir.
I didn’t exactly understand about the format?
[29-03-2025 16:51] PPM 1: See their case report structure, which is how journals want us to share the
patient data and see our conversational PaJR case report format which is different.
So you will need to change our current two case reports into the jimcr journal publishable format. Also
check out the other case reports in the jimcr journal
[29-03-2025 16:54] PPM 1: @~RK would be interesting to check if AI can help convert all our current
case reports here👇
https://pajrcasereporter.blogspot.com/?m=1
into journal publishable format in which case we could retain the current conversational PaJR format
and also add a structured format to each our published PaJR cases?
Also can AI help us to count how many active PaJR cases we have accumulated ever since @CR
logged her first case report in the above link?
[29-03-2025 17:03] PPM 4: Okay sir
[29-03-2025 20:53] PPM 4: CHIEF COMPLAINT:
Palpitations and tremors in hands since five years.
HISTORY OF PRESENTING ILLNESS:
The patient was apparently asymptomatic five years ago.
Then, she became pregnant, around the same time when she noticed that she was having palpitations, coarse tremors and sweating. She also reported feeling tired. Upon visiting the doctor, she was found to have hyperthyroidism, for which she was prescribed Propylthiouracil 50mg by a local practitioner.
She has followed up with the practitioner once when she had initially been prescribed the medication, but hasn’t followed up regularly with them after that.
One month ago, she has visited the dental hospital where the doctors had referred her to the department of general medicine to assess her apparent goiter and exophthalmos.
MENSTRUAL HISTORY:
Patient attained menarche at 12 years. She has a regular cycle of 5 days for every 28 days, no menorrhagia or dysmenorrhea, sometimes associated with clots.
PAST OBSTETRIC HISTORY:
The patient has two children, who are both alive and healthy.
First child, male, was born four years ago, through LSCS.
Second child, female, was born nine months ago, through LSCS.
The mother has taken the same dose of Propylthiouracil throughout both pregnancies. She reports no exacerbation of symptoms.
MEDICATION HISTORY:
Initially the patient took Propylthiouracil 50mg prescribed by a local practitioner.
After being referred here, her presrciption has changed to Carbimazole 10mg and Propranolol Sustained Release 20mg.
The patient is on no other medication.
PAST HISTORY:
N/K/C/O DM, HTN, TB, Thyroid, Asthma, CAD, CVA
LSCS deliveries in the years 2021 and 2024.
FAMILY HISTORY:
No relevant family history.
PERSONAL HISTORY:
The patient is a home-maker. She appears mentally troubled by her thyroid issue.
Diet- mixed Appetite- decreased Sleep- normal Bowel and bladder- Regular
The patient used to consume toddy occasionally, but stopped doing so after she got married 6 years ago.
[29-03-2025 21:11] M: Who is working on this sir? How can i help?? Please let me know..
[29-03-2025 21:20] PPM 1: @~PPM3 @~PPM4 are working on publishing this in jimcr and you can
join us by helping to restructure it as per the jimcr format! It's already logged here as a PaJR case report
and is regularly updated in the case report link shared here in the description box. There's another
hyperthyroid lady of similar age shared above which can be combined if we can again work on her
current issues further by telephonic communication with the patient @~PPM4
[29-03-2025 22:15] M: Okay sir
[29-03-2025 22:15] M: Got it
[29-03-2025 22:15] M: @~PPM4 @~PPM3 can you guys share me the draft if you have started
forming the manuscript?
[30-03-2025 08:33] PPM 4: We haven’t started yet ma’am, we’ll share once we do!
[30-03-2025 09:24] M: Sure!
[30-03-2025 13:01] PPM 1: Guess the three of you are all 2021 MBBS batch?
[30-03-2025 13:02] PPM 1: @~PPM5 @~PPM3 when are you going to add the primary patient advocate here?
[30-03-2025 13:04] PPM 4: Sir, the patient’s advocate is already in the group.
I shared a link with them day before yesterday and they joined yesterday.
[30-03-2025 13:08] PPM 1: You mean the patient's primary advocate because we are supposed to keep
the patient deidentified
[30-03-2025 13:13] PPM 4: Yes sir, my mistake
[30-03-2025 15:45] RK: I gave this prompt -
Can you take a look at this blog
https://pajrcasereporter.blogspot.com/2025/03/36f-with-graves-disease-diagnosed.html?m=1
And rewrite it in this format
https://kundaliniresearchinstitute.org/wp-content/uploads/2023/10/Brogan-2019-Adv-Mind-Body-Med.pdf
Please read the images in the blog to get all info.
.. and got AI to give this back
Abstract
This case report discusses a 36-year-old female diagnosed with Graves' disease in August 2023. Despite medical management with carbimazole, she presented with persistent symptoms and new developments, including increased thyroid swelling and nail changes. This report examines her clinical presentation, treatment course, and the considerations for managing Graves' disease.
Introduction
Graves' disease is an autoimmune disorder characterized by hyperthyroidism due to circulating autoantibodies. Common symptoms include goiter, ophthalmopathy, and dermopathy. This case highlights the challenges in managing Graves' disease and the importance of monitoring for disease progression and treatment side effects.
Case Report
Patient Information
Age: 36 years
Gender: Female
Diagnosis: Graves' disease (August 2023)
Clinical Presentation
The patient was diagnosed with Graves' disease in August 2023 and initiated on carbimazole 10 mg once daily. She reported increased sweating and, upon examination, exhibited mild eye signs and fine tremors. Over the past year, she noted increased thyroid swelling and nail changes.
Diagnostic Assessment
Specific diagnostic test results, including thyroid function tests (T3, T4, TSH levels), thyroid autoantibodies, and imaging studies, were not detailed in the available information.
Therapeutic Intervention
The patient was prescribed carbimazole 10 mg once daily since her diagnosis. In response to the increased thyroid swelling and persistent symptoms, a discussion among healthcare providers considered increasing the carbimazole dose to 10 mg three times daily, with a review planned in one month.
Follow-Up and Outcomes
Follow-up details, including the patient's response to the adjusted treatment regimen and any changes in clinical or laboratory findings, were not provided in the available information.
Discussion
This case underscores the importance of regular monitoring and timely intervention in managing Graves' disease. The patient's persistent symptoms and new developments, such as increased thyroid swelling and nail changes, prompted consideration of treatment adjustment. The discussion among healthcare providers highlighted the debate over dosing frequency and the potential benefits of once-daily versus divided doses of carbimazole. Studies have shown that a single daily dose of carbimazole can be as effective as divided doses in inducing euthyroidism, with potential benefits for patient compliance.
Conclusion
Effective management of Graves' disease requires individualized treatment plans and ongoing assessment of therapeutic efficacy. This case illustrates the need for clinicians to remain vigilant for signs of disease progression or treatment side effects and to adjust management strategies accordingly.
Consent
The patient's de-identified health data were shared after obtaining her signed informed consent.
References
Frontiers in Endocrinology. "Carbimazole dosing in the treatment of Graves' disease."
https://www.frontiersin.org/articles/10.3389/fendo.2020.00286/full
Note: This case report is based on limited information provided in the blog post and may not include all
necessary clinical details typically found in comprehensive medical case reports.
[30-03-2025 15:46] RK: Nowhere close to the detail that exists in all the images.. will think about how
to extract everything more comprehensively from the blog.
[30-03-2025 15:53] PPM 1: But still a great help!
👏👏
@~PPM4 @~PPM3 @~~M let's do this also for our previous thyrotoxicosis patient whose case report I
shared above
And then let's submit it to the journal.
What is "integrative medicine" about our work? Well that's again a lot of review of literature that we have already been doing for the conversational commentary that can also be used there
[30-03-2025 15:54] PPM 1: Which LLM? Currently I don't find any LLM reading URLs unless they are
premium versions.
[30-03-2025 16:01] RK: ChatGPT free version only but with the search button selected
[30-03-2025 16:03] RK: I'm experimenting with locally running LLMs on my machine and with agentic AI (using model context protocol MCP), hoping to get better results with that. With MCP, we can ask AI to first fetch the data, then individually look at images and text and then collate all answers from each of the tasks together at the end. Will keep you posted on the experiments. Early stages, images are a challenge.
[30-03-2025 16:04] PPM 1: Looks like the patient's primary advocate left!
We forgot that for primary PaJR patient advocates being in these technical discussions could be problematic and perhaps we need to create two separate PaJR groups for them (one for their data sharing and another for our analysis)!
[30-03-2025 16:05] RK: uh oh! will continue this on the conversational commentry group
[30-03-2025 16:05] PPM 1: Great to hear this
[30-03-2025 16:06] PPM 1: Now that they have left we can continue here and @~PPM4 can
create another PaJR primary data capture group for this patient
[30-03-2025 16:08] PPM 1: In the current commentary perspective it's interesting to note how our
world of two dimensional academic analysis is so much removed from the patient's multi-dimensional
reality!
[30-03-2025 16:09] PPM 1: Bridging this gap is akin to try and make out our hospital area.
syndrome patient's head touch the bed! https://medicinedepartment.blogspot.com/2025/03/project-7-years-in-narketpally.html?m=1
[30-03-2025 16:24] PPM 4: Sir, I just called them up and they don’t have anyone that understand
English in their family, so they got a little overwhelmed and left
I told them I’d explain them what to do, and added them back, but if its easier, I’ll make another group
for them so that its less overwhelming
[30-03-2025 20:45] M: Okay sir, we can include a timeline flowchart and patient reported outcomes if
atleast 1 figure and 1 table is allowed… it will give a multidimensional realisitic capture as experienced
by the patient + our 2D analysis :))
[30-03-2025 20:46] PPM 2: @Meta AI have we vetted this in patient centered trials?
[30-03-2025 20:46] Meta AI: To answer your question accurately, I need more context about the
specific treatment or intervention you're referring to. Can you please provide more details or clarify
what you mean by "this"?
[30-03-2025 20:47] PPM 2: @Meta AI that avoiding such foods actually improves Graves disease
[30-03-2025 20:47] Meta AI: There is limited research on the impact of specific diets on Graves'
disease. However, some studies suggest that avoiding foods that trigger inflammation or impair thyroid
function may help alleviate symptoms.
Here are some foods that may be beneficial to avoid:
1. Gluten: Some people with Graves' disease may have a gluten intolerance or sensitivity, which can exacerbate symptoms.
2. Soy: Soy products contain isoflavones, which may interfere with thyroid function.
3. Raw cruciferous vegetables: While cooked cruciferous vegetables are nutritious, raw ones contain goitrogens, which may impair thyroid function.
4. Processed foods: Processed foods often contain unhealthy ingredients, added sugars, and sodium, which can worsen inflammation.
Keep in mind that everyone's experience with Graves' disease is different, and it's essential to consult with a healthcare professional before making significant changes to your diet.
[30-03-2025 20:47] PPM 2: @Meta AI please share a patient centered trial to support your hypothesis
[30-03-2025 20:47] Meta AI: Unfortunately, I couldn't find a specific patient-centered trial that supports the hypothesis that avoiding certain foods improves symptoms of Graves' disease. However, there are some studies and guidelines that discuss the importance of diet and lifestyle changes in managing Graves' disease.
Dietary Considerations for Graves' Disease
- Some studies suggest that avoiding foods that trigger inflammation or impair thyroid function may help alleviate symptoms ¹.
- Foods that may be beneficial to avoid include gluten, soy, raw cruciferous vegetables, and processed foods.
Lifestyle Changes for Graves' Disease
- Quitting smoking and reducing stress may also help manage symptoms ¹.
- Getting regular exercise and maintaining a healthy weight can also improve overall health.
If you're looking for more information on patient-centered trials or studies on Graves' disease, I recommend searching through reputable sources such as the National Institutes of Health (NIH) or the American Thyroid Association (ATA).
[30-03-2025 20:47] Meta AI: https://www.ncbi.nlm.nih.gov/books/NBK448195/
[30-03-2025 20:52] PPM 2: @~~M what is the current situation with the patient at the moment?
[30-03-2025 21.46] PPM 1: Thanks @~PPM4 @~PPM3 We can ask @~PA to share her daily hourly
activities and food plates?
[30-03-2025 21:46] M: Hello sir, I’m based in Indore 😅 so don’t know if you are asking about the real
time update..
[30-03-2025 21:48] PPM 2: Oh I see. I thought you were aware of the patient's current status.
Apologies.
[30-03-2025 21:48] M: No worries sir :)
[30-03-2025 22:13] PPM 1: @~PPM4 @~PPM3 can answer this as they are the ones who handled the
patient from our hospital campus and are still in touch.
Our integrative medicine case report may not be about diet or lifestyle modification as much as it could be about cultural integration!
""integrative medicine is essentially an application of different “culturally sensitive” health care approaches, optimally tailored to a given patient's needs and difficulties.
Efforts are needed at the clinical, research, and administrative levels to reduce the “othering” phenomenon seen in health care approaches that are often detrimental to efficient patient care.
There is a need to promote collaboration between different disciplines and generate evidence base to optimize integrative medical practice further."
https://www.liebertpub.com/doi/10.1089/imr.2022.0054
@~~M @~PPM4 this will be the pivotal introduction to our integrative case report on our current two
patients of thyrotoxicosis.
Who shall form the other patient's PaJR and gather current data? She had another interesting issue of
painful penicillin prophylaxis that we stopped!
[30-03-2025 22.36] PPM 4: Yes sir, I’ll get in touch with her again to do so.
[30-03-2025 22:42] PPM 4: Sir, currently she’s on Carbimazole 10mg thrice daily and
Propranolol sustained release 20mg once daily.
Upon talking to her, she doesn’t really report any symptoms bothering her, the way she said they did
before she was taking any form of medication at all, but she does seem a little mentally troubled by her
problem.
If there’s anything specific I couldn’t clarify, please let me know so I can get back about it more
accurately :)
[30-03-2025 22:44] PPM 4: Sir, I can get in touch with the other patient and make a PaJR for her.
[30-03-2025 23:08] PPM 1: That would be great. @CR has her consent form that has her number and I guess you have already seen her link to the case report
[30-03-2025 23:09] PPM 1: When did she start having symptoms and after how many days of that did
she start medication and what dose for how long?
PPM 1: 👍
[31-03-2025 08:22] PPM 4: Okay sir, I will get in touch with them.
[31-03-2025 08:26] PPM 1: Yes if you see the first prescription image in her case report dated January
2021 you will find mentioned as post partum.
Let's also add this initial history narrative text in the case report beginning @CR
Let's elaborate her events sequences
What were her thyroid function tests like since 2021?
[31-03-2025 09:05] PPM 1: She never had normalisation of her thyroid profile and yet remained asymptomatic?
Can we have an event timeline of her symptoms as to when did she actually experience her symptoms
of thyrotoxicosis and when was she symptoms free?
[31-03-2025 12:49] PPM 2: And has she ever gotten tested for antibodies? Not for diagnosis but will
need it for future pregnancy if planning.
[31-03-2025 12:51] PPM 1: She had her initial illness during her first pregnancy and the second
pregnancy happened unnoticed with no issues at delivery of the second
[31-03-2025 12:53] PPM 2: Serendipity! Might as well check.
[31-03-2025 12:53] PPM 2: But no eye signs I hope
[31-03-2025 12:55] PPM 1: Very much present. Check the video taken by @~PPM3 and uploaded by
@CR
[31-03-2025 12:55] PPM 2: Oh yes now I remember. Yes then we should perhaps get antibodies
checked.
[31-03-2025 12:55] PPM 2: TPO and TRAbs
[31-03-2025 13:00] PPM 1: How will that help? Let's assume they are positive as in a chess game. What
would we do next differently than what we are doing now?
[31-03-2025 13:07] PPM 2: Positive 3x or more is significant. If yes, then would recommend delaying
pregnancy.
[31-03-2025 13.17] PA: Lunch
[31-03-2025 15:11] PPM 4: Yes sir, even when I was asking her if she had any symptoms currently, she
said that she had no problem with any of the typical symptoms, like palpitations or sweating.
As she got pregnant the first time, she started to feel palpitations, for which she went to the doctor. After
that, she said she started to feel better gradually, and she’s currently asymptomatic now.
[31-03-2025 18:04] PPM 1: Since when is she asymptomatic?
[31-03-2025 19:40] PPM 4: Sir, she said she was asymptomatic ever since she was started on Propylthiouracil, she found that her symptoms disappeared gradually over a period of time and then hasn’t experienced them since.
[31-03-2025 20:15] PPM 1: Asymptomatic since 2021?
[31-03-2025 21:08] PPM 4: Yes sir
[01-04-2025 08.30] PA:
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