zaki
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A 24-year-old woman who is 3 months post partum presents with severe anxiety. She is not nursing. She has lost all her pregnancy-associated weight and now weighs 4.5 kg (10 lb) less than before her pregnancy. She is having difficulty sleeping and is aware of palpitations. She tells you that at age 13 she was diagnosed with Graves’ disease. She was treated with propylthiouracil for 2 years and was euthyroid thereafter.
On physical examination, stare and lid lag are evident. Her pulse is 100/min, and she is tremulous. The thyroid gland is slightly enlarged.
Laboratory studies:
Serum T4 16.5 µg/dL
Free T4 index 18.6
Serum T3 210 ng/dL
Serum thyrotropin (TSH) < 0.01 µU/mL
What is the most appropriate next step?
(A) Begin therapy with propylthiouracil or methimazole.
(B) Discuss the options of therapy, which include radioiodine (131I), antithyroid drugs, and surgery.
(C) Treat the patient with propranolol therapy and reassurance.
(D) Order a radioactive iodine uptake and scan.
(E) Careful observation only is needed.
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Maverick
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| veri
Forum Newbie
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B?
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| helpful
Forum Junior
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A) Begin therapy with propylthiouracil or methimazole.
and than
(D) Order a radioactive iodine uptake and scan.
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| Medicine Guy
Forum Junior
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A and B and C
as we already have the thyroid profile, we can straight way start her on medication.
But if only one option, then B.
She needs to be evalutated properly and then the appropriate medication.
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| alice8
Forum Guru
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Posts: 643
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B) Discuss the options of therapy, which include radioiodine (131I), antithyroid drugs, and surgery.
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