English medical record fever to be investigatedName Aiyu Sun Age 37 Gender Female Race the Han nationality Birth Place HongHu City Marital Status Married Occupation Farmer Address Group Six WeiGou Vil

piratory tract infection” by the local hospital and was given antibiotics. However, the fever did not subside and the patient was admitted to our hospital for further investigation.

Past Medical History: The patient had no history of chronic diseases, surgery or hospitalization.

Family History: The patient’s parents and siblings are healthy.

Social History: The patient is a farmer and lives in a rural area. She denies smoking, alcohol consumption or illicit drug use.

Physical Examination: The patient appeared uncomfortable with a temperature of 38.5°C, heart rate of 98 beats per minute, respiratory rate of 20 breaths per minute and blood pressure of 120/80 mmHg. Head and neck examination revealed exophthalmos, palpable thyroid gland and tender cervical lymph nodes. Cardiovascular, respiratory, abdominal and neurological examinations were unremarkable.

Investigations: Blood tests showed elevated white blood cell count (11.2109/L) with neutrophilia (10.0109/L), elevated C-reactive protein (37.8 mg/L) and normal liver function tests. Thyroid function tests showed FT3>25pg/ml↑, FT4>8npg/dl↑ and TSH<0.01uIU/ml↓, indicating uncontrolled hyperthyroidism. Chest X-ray was normal. Throat swab culture was negative for bacterial growth.

Diagnosis: The patient was diagnosed with uncontrolled hyperthyroidism and fever of unknown origin.

Treatment: The patient was started on intravenous fluids, antibiotics and antipyretics. Tapazole dose was increased to control hyperthyroidism. Further investigations, including thyroid ultrasound and nuclear medicine scan, were planned.

Follow-up: The patient’s fever subsided after two days of treatment. Thyroid ultrasound showed diffuse thyroid enlargement with increased vascularity, consistent with Graves’ disease. Nuclear medicine scan confirmed the diagnosis and showed no evidence of thyroid nodules or malignancy. The patient was advised to undergo radioactive iodine treatment or surgery for definitive management of hyperthyroidism