Methimazole-Induced Pleural Effusion in the Setting of Graves’ Disease

Table 1

Detailed laboratory and procedures.

Thyroid Function Tests	Initial Presentation: TSH <0.005 (0.358-3.740)
	Free T4 2.78 (0.76-1.46)
	Free T3 7.35 (2.18-3.98)
	9 days after medical optimization: TSH <0.005
	Free T4 1.54
	Free T3 2.80
	Hospital Course: TSH <0.005, Free T4 1.87, free T3 2.56
ANA	>1:80, positive and speckled pattern
Anti-Double stranded antibody	Negative
Antimyeloperoxidase antibody	Positive
c-ANCA	Positivenormal one and a half weeks after methimazole was discontinued.
p-ANCA	Negative
CT chest	Pleuritic, pneumonitis and mediastinal lymphadenopathy
CT abdomen	Ruled out intraabdominal etiologies such as malignancies
Bronchoscopy with EBUS	Negative for granulomatous disease, infection or malignancy
Bronchoalveolar Lavage (BAL)	Neutrophil predominant fluid with bacterial, fungal and AFB cultures negative.
	Cytology negative
Mediastinal Lymph Node Biopsy	Negative