Thyrotoxicosis and antithyroid drugs.

Accepted 21 August 1996 A 78-year-old woman presented with fever and a sore throat for five days. Oral Augmentin (amoxicillin/clavulanate potassium) did not reduce the fever. Seven weeks prior to this episode Graves' disease had been diagnosed and treatmnent with methimazole 40 mg once a day and propanolol 10 mg qid was started. On admission, her temperature was 37.6°C, blood pressure was 100/70 mmHg and heart rate 76 beats/min. She had severe aphthous stomatitis with many ulcerations. The thyroid gland was palpable. Physical examination was otherwise unremarkable. Thyroid-stimulating hormone was 0.8 mU/l (normal 0.3-5.0 mU/l) and free thyroxine was 18.9 nmol/l (normal 9.5-22.4 nmol/l). A blood film (figure) was examined.