Scenario: A 35-year-old female presents with complaints of a rapid heartbeat, excessive sweating, difficulty sleeping, irritability, and weight loss of 25 lb in the last 4 months despite having an increased appetite. Upon further questioning, she reports frequently feeling hot, having increased loose stools or diarrhea, and thinning of her hair. She has no other past medical history. Family history reveals a history of maternal “thyroid issues” and paternal hypertension. Past routine physical examinations document heart rates in the 70s and blood pressures around 110/70, but today her blood pressure is 135/90 and heart rate is 110 beats per minute. On examination, you note a fine tremor in her hands, bulging eyes, pretibial myxedema (PTM), and a diffusely enlarged thyroid.

Question: What are two primary functional goals to be prioritized with a patient presenting with Graves’ disease?

Potential answers:

1. Functional aerobic capacity and full range of motion of the extremities
2. Functional gait and normal urinary continence
3. Ability to fully orient cognitively and perform self-care independently
4. Functional aerobic capacity and functional gait

Answer with rationale: Functional aerobic capacity and functional gait

Functional aerobic capacity is a primary concern for these patients, as they typically develop shortness of breath and are easily fatigued.

Functional gait is another primary concern for patients with Graves’ disease, as they commonly develop weakness and muscular atrophy. 

Self-care is a common secondary issue for these patients due to muscular weakness and decrease functional aerobic capacity. 

Urinary incontinence is a potential symptom with Graves’ disease, but is not as commonly seen as muscular weakness and decreased aerobic capacity. 

Range of motion and cognition are not common issues seen with Graves’ disease. 

^{For more information see Chapter 47 in The Color Atlas of Physical Therapy}