Hyperthyroidism, Exophthalmos, Pretibial Myxedema, and Early Clubbing. Presented by Samuel M. Bluefarb, MD, and Lawrence A. Adams, MD.
A 58-year-old Negro man was essentially well until November 1962, when he developed an acute glomerulonephritis following a streptococcal pharyngitis. During a subsequent hospitalization, a diffusely enlarged thyroid and slight prominence of the eyes were noted. The T3 uptake was 52.6% and the protein-bound iodine (PBI) 9.8μg /100 cc.In September 1965, he was admitted to the Veterans Administration Research Hospital with a two-month history of progressive nervousness, weakness and swelling of his feet. Positive physical findings at that time included a diffuse goiter, 4+ pitting ankle edema, and very prominent exophthalmos. Laboratory data revealed131I uptake, 100% in 24 hours; T3 uptake, 46.7%; PBI, 11.5μg/100 cc; thyroid scan, enlargement of the right lobe; and basal metabolic rate (BMR), +17%. There was also clinical and laboratory evidence of a nephrotic