A 30-year-old lady, presented with progressive neck swelling in the past 2 years. She has bilateral hands tremor and palpitation. On examination, there is anterior diffuse neck swelling, moving up with swallowing. Blood investigation is as following:

TSH <0.005 (0.45-4.50 mIU/L)

T4 30.0 (12-22 mmol/L)

Ultrasound neck revealed hyper vascularised thyroid gland.

1) State the most likely diagnosis.  (2 marks)  

Graves Disease with hyperthyroidism

2) List THREE (3) associated systemic signs of the above diagnosis (3 marks)

Graves opthalmopathy, pretibial myxedema, thyroid acropachy

3) State diagnostic investigation to confirm the above diagnosis (1 mark)

Thyroid-stimulating hormone antibody

4) List TWO (2) the arterial supply to the affected organ (2 marks)

Superior thyroid artery, Inferior thyroid artery

5) State TWO (2) managements for this patient (2 marks)

i-as thyroid hormone regulator: Carbimazole

ii- as symptom control: Beta-blocker

iii- surgery

iv- radioablation