usmle6789
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76 yr old man had fatigue and loss of interest in daily activities over the past 4 months. He sleeps poorly and had a 4.5 kg[10 lb] weight loss during this period. He states that he has probably lived long enough. Bp 110/78, pulse 68. examination shows a slow return of deep tendon reflexes. Measurement of which of the following is the most appropriate next step in management?
1] ca+2
2] Creatinine
3] Glucose
4] Testosterone
5] TSH
My answer is 5. Is it hypothyroidism?
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| ELM
Forum Guru
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Hypothyroidism---->dementia-depress---->wieght loss and all other depression stuff will show. Any older person with depress or demential problem---> TSH is the top of the choise.
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ELM
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| SA
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What next in this case ELM? Just for my own intrest as your answer is 100 % corect.
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| ELM
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If it's confirmed that he has Hypothyroid just give him T4/L-Thyroxin- thyroid hormons starting with lower doses first and gradually incease the dose until TSN is in normal limit and then continue on with that dose, ----> he will be dancing. I mean hypothyroid induced dementia is one of the reversible dementia.
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ELM
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| SA
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I mean what next step if TSH is normal in this case?
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| noelle
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IF TSH NORMAL DO T3, T4 COZ IT COULD BE THOSE EUTHYROID SICK SYNDROME ANOTHER CAUSE OF HYPOTHY.
2 TYPES OF EUTYROID SICK SYNDROMES. I] MOST COMMON AKA LOW T3 SYNDROME .. LABS T3 LOW ...T4 NORMAL.. TSH NORMAL
2] T3 LOW ..T4 LOW ..TSH NORMAL... SEVERITY OF HYPO IS ALWAYS BASED ON LEVELS OF T3...  LOWER THE WORSER.
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| ELM
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I am not sure about euthyroid sick Sx causes dimentia-depress, aren't they suppose to be complitely normal on those conditions......I think so, I don't think sick euthyroid Sx causes dimentia.
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| noelle
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BUT T3 LOW, RIGHT? SO THE EFFECT OF THYROID HORMONES NOT THERE . SO I GUESS ITS AGAIN LIKE HYPOT. SO DEPRESSION , ETC..DEP. COOULD BE CAUSING PSEUDO DEMENTIA . WHAT DO U SAY ??
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| Veer-Zaara
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My answer is to do TSH....it can be hypothyroidism or depression??Even in depression the TSH levels are low.None of the other answers make much sense.
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