Key elements are written in red, with bold and italics.

I – Hello, my name is ______________ and I am a JMO.

S – I have a 28-year-old woman with suspected Graves’ disease who presented with symptoms of fatigue and anxiety. She also reported episodes of heat intolerance, heart palpitations, and 10kg of unintentional weight loss over the last 2 months.

B – No significant past medical or social history, she has a family history of autoimmune disease. On examination she appeared agitated with a resting tremor and was mildly tachycardic and hypertensive. She had prominent proptosis and apparent lid lag, as well as brisk reflexes and a diffusely enlarged thyroid gland. A TFT showed low TSH, high T3 and T4, and positive for TSH receptor antibodies. An ECG showed sinus tachycardia.

A – My assessment is that this is hyperthyroidism due to Graves’ disease.

R – I recommend she see an endocrinologist to be started on treatment for symptom control and long-term therapy.

Needed to win

Need to include all 5 sections of ISBAR, plus mention at least 4 of the following:

1. At least 3 out of the 5 symptoms (fatigue, anxiety/trouble sleeping, heat intolerance, palpitations, unintentional weight loss).
2. Family history of autoimmune disease.
3. Eye symptoms, enlarged thyroid gland, and TFT results.
4. Hyperthyroidism likely due to Graves’ disease.
5. See an endocrinologist/senior physician.