Grave’s disease, hyperthyroidism moderate, decompensation stage. Endocrine ophthalmopathy.

№	Rating steps
1.	Collection of complaints and anamnesis	Carried regularly and systematically
2.	Refinement asked additional questions due to differential diagnosis .	Asked questions were on dieses symptoms
3.	Physical examination (skin, mucous membranes, DUI and etc.)	Objective examination of height and weight, skin and mucous membrane. Normasthenic. Decreasing of subcutaneous fat skin thickness
4.	Examination of the cardiovascular system .	Find out boundaries of the relative dullness of the heart and apex of the heart. Make auscultation of the heart in series.
5.	Measurement of blood pressure, pulse rate determination	According to the rules of pulse measuring and blood pressure.
6.	Palpation of the thyroid gland	Palpation of the thyroid gland was made in series.
7.	Definitions of eye symptoms .	Identified the symptoms of Graefe, Kocher, Mobius
8.	Preparation of predicted diagnosis and its justification .	Exposed preliminary diagnosis of complaints, anamnesis and physical examination.
9.	Preparation of differential diagnosis	In order to avoid neurocirculatory dystonia: Lack of eye symptoms, progressive weight loss, tachycardia at rest and increased thyroid gland. Antibody to TSH receptors, free T4 and T3. Toxic thyroid adenoma: lack of eye symptoms, pretibial myxedem
10.	Laboratory research plan assignment .	GBA,UA, BBA: glucose, total protein, cholesterol, potassium, calcium, bilirubin.
11.	Interpretation of hormonal study (TSH, T3, T4 in the blood)	Decrease levels of TSH, raising of unbound T3 and unbound T4
12.	Interpretation of biochemical analysis of blood	Insignificant hypercholesterolemia, hyppotassiumemia.
13.	Assignment of instrumental research plan .	Thyroid gland ultrasound, ECG, echocardiography.
14.	Thyroid gland ultrasound interpretation	The thyroid gland is diffusely enlarged, hypoechoic. The total volume is 36 cm3.
15.	ECG interpretation	Sinus tachycardia, pulse 110, EHO is shifted to the left. Left ventricular hypertrophy.
16.	Eye ultrasound interpretation	The acute phase of endocrine ophthalmopathy, moderate. Muscle hypertrophy. Myopia 1 degree
17.	Final diagnosis principles	Put diagnosis on the basis complaints, medical history, physical examination, decreased TSH, raising unbound T3 and unbound T4, a little amount of hypocholesterolemia, hypokalemia, ultrasound of the thyroid gland; The thyroid gland is diffusely enlarged, hypoechoic. The total volume is 36 cm3; US eyes; The acute phase of endocrine ophthalmopathy, moderate. Muscle hypertrophy. Myopia 1 degree, ECG; Sinus tachycardia, EHO is shifted to the left. Left ventricular hypertrophy. The syndrome of hyperthyroidism, GV (Graves' disease), moderate hyperthyroidism, decompensated. Endocrine ophthalmopathy.
18.	disease treatment principles -tireostathicks -symptomatic treatment	1. Drug therapy: tireostatheic(tirozol, Mercazolilum) 2. Treatment І131 3. Surgery 4. Symptomatic treatment (beta blocker, sorbent, sedatives)
19.	Maximum benevolent attitude to make patient feel comfort	Maximum friendly attitude and the patient calmed down.