A 30-year-old lady with hyperthyroidism is on carbimazole 40 mg/day from last 6 months. She has no ophthalmoplegia, no visual goiter and she is on USG thyroid solitary nodule and guided FNAC. Nodule shows colloidal goitre, on other medication except propranolol for rate control. BP & other systemic. No significant abnormality, Weight 45 kgs. She is on regular carbimazole (no H/O self-intake of levothyroxine).
Inspite of regular medication, TSH is <0.8 in 3 separate occasion with raised FT4 in last 6 months .I have done Anti-TPO which is 1300 (norm <60). Is it due to graves or toxic nodular goitre? I131 is not available in my set up so what's the next step I can do? I,m planning to add prednisolone 40mg/day with lithium. Can I try this? What is the maximum dose for carbimazole?
