Severe Leg Cramps and High TSH! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     53,816 Members     234,831 Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-17-2011
drnrpatel's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 440
Threads: 153
Thanked 385 Times in 209 Posts
Reputation: 408
Thyroid Severe Leg Cramps and High TSH!

A 45-year-old man complains of severe cramps in his legs for the past 30 days. He previously has been healthy with no complaints. He takes no medications, denies drug use, and rarely consumes alcohol. He has no chest pain or shortness of breath. When specifically questioned, he reports that he has been feeling increasingly fatigued. On examination, he appears lethargic. His vital signs are stable. Lungs are clear. Cardiac examination is unremarkable. His muscle strength is intact. Laboratory studies show a normal hematocrit, an elevated thyroid-stimulating hormone level, and normal T3 and T4 levels. Which of the following is the most appropriate management?

A. Methimazole therapy
B. Observation
C. Radioactive iodine therapy
D. Thyroidectomy
E. Thyroxine therapy
Reply With Quote



  #2  
Old 10-17-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 49
Threads: 10
Thanked 4 Times in 4 Posts
Reputation: 14
Default

thyroxin ?????
Reply With Quote
  #3  
Old 10-17-2011
drnrpatel's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 440
Threads: 153
Thanked 385 Times in 209 Posts
Reputation: 408
Correct Answer Answer

The correct answer is E. The patient is hypothyroid as shown by the elevated thyroid-stimulating hormone (TSH). If his T3 and T4 were diminished also, this diagnosis would have been certain. If he were asymptomatic and had normal T3 and T4 levels, then he would have subclinical hypothyroidism. He has normal T3 and T4 but is symptomatic with leg cramps and lethargy. This should be treated with thyroxine, and the TSH level should be rechecked in 6 weeks.
Methimazole (choice A) would be used in treating hyperthyroidism. Agranulocytosis is a possible adverse side effect.
Observation (choice B) would be appropriate if the patient had subclinical hypothyroidism.
Radioactive iodine therapy (choice C) would be used for the treatment of Graves disease.
Surgery would have no role in the initial management of hypothyroidism (choice D).
Reply With Quote
  #4  
Old 10-17-2011
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 175
Threads: 13
Thanked 197 Times in 58 Posts
Reputation: 207
Default

I have a question and it might sound stupid but please bear with me. How can a guy with normal t3 and t4 levels actually have symptoms of hypothyroidism? The thing is that the problems of hypothyroidism is due to a decrease in the T3 and T4 lvl which arent seen here.TSH while is indicative of a primary throid problem doesnt have anything to do with the symptoms.

I ask this as on reading the question i also figured he was probably hypothyroid from the symptoms and from the high TSH . But since the lvl of t3 and t4 are normal i got confused and counld figure out a how a person can be hypothyroid bt still have normal values.
Reply With Quote
  #5  
Old 10-17-2011
drnrpatel's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 440
Threads: 153
Thanked 385 Times in 209 Posts
Reputation: 408
Idea!

Question doesn't mention Free levels of T4 and T3... So unless specified these levels are considered total T3 and T4 and so, TSH and symptoms are the only criteria you have to rely on... Hope it helps...
Reply With Quote



Reply

Tags
Endocrinology-, Internal-Medicine-, Step-2-Questions

Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Sudden Severe Headache rasheed USMLE Step 1 Classic Clues 2 02-17-2013 11:37 PM
Severe asthma management ag2011n USMLE Step 2 CK Forum 1 09-17-2011 01:49 AM
Abdominal cramps, hypotension, bradycardia surez18 USMLE Step 1 Forum 7 08-22-2011 08:52 AM
Muscle cramps in hypothyroidism? Pav100 USMLE Step 2 CK Forum 5 09-27-2010 10:15 AM
Tachypnea after severe trauma good_boy_1234 USMLE Step 2 CK Forum 4 06-12-2010 10:02 AM

RSS Feed
Find Us on Facebook

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)