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Old 06-01-2012
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Thyroid Hypothyroidism; Next Step in Management!

A 55-year-old woman is evaluated for a 7-month history of worsening fatigue. She also reports that her hair is thinning and she has an unexplained weight gain of 4.1 kg (9 lb) despite trying to limit food intake. She has no other medical problems and takes no medications.
On physical examination, temperature is 36.7C (98.0F), blood pressure is 120/70 mm Hg, pulse rate is 60/min, and respiration rate is 12/min. BMI is 27. The thyroid is twice its normal size. Her voice is normal, and deep tendon reflexes are 2+ throughout. The remainder of the physical examination is normal.
Laboratory evaluation reveals a serum thyroid-stimulating hormone (TSH) level of 14.1 μU/mL (14.1 mU/L) and a free thyroxine level of 0.9 ng/dL (12 pmol/L).

Which of the following tests are necessary before initiating therapy?

(A) Measurement of thyroid peroxidase (TPO) antibody
(B) Radionuclide uptake scanning
(C) Measurement of thyroglobulin level
(D) No additional tests
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Old 06-01-2012
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well the diagnosis is hypothyroidism. the treatment for which is thyroxine

(A) Measurement of thyroid peroxidase (TPO) antibody -- will diagnose hashimotos.. but WILL NOT change diagnosis

(B) Radionuclide uptake scanning -- will show decreased uptake cos its hypothyroid -- but a little confused about this.


(C) Measurement of thyroglobulin level-- no indication to measure this in the question
they wud be increased with pregnancy/ocp
and decreased with nephrotic/steroids

(D) No additional tests

most likely answer B or D.
i know if it were hyperthyroid we'd do B

but i think with hypothyroidism go straight to treatment?? so no furthur tests
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Old 06-01-2012
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Quote:
Originally Posted by tyagee View Post
A 55-year-old woman is evaluated for a 7-month history of worsening fatigue. She also
reports that her hair is thinning and she has an unexplained weight gain of 4.1 kg (9 lb)
despite trying to limit food intake. She has no other medical problems and takes no
medications.
On physical examination, temperature is 36.7C (98.0F), blood pressure is 120/70 mm Hg,
pulse rate is 60/min, and respiration rate is 12/min. BMI is 27. The thyroid is twice its normal
size.
Her voice is normal, and deep tendon reflexes are 2+ throughout. The remainder of the
physical examination is normal.
Laboratory evaluation reveals a serum thyroid-stimulating hormone (TSH) level of 14.1 μU/mL
(14.1 mU/L) and a free thyroxine level of 0.9 ng/dL (12 pmol/L).
Which of the following tests are necessary before initiating therapy?
(A) Measurement of thyroid peroxidase (TPO) antibody
(B) Radionuclide uptake scanning
(C) Measurement of thyroglobulin level
(D) No additional tests
(D) No additional tests

Quote:
The thyroid gland may become firm, large, and lobulated in Hashimoto's thyroiditis, but changes in the thyroid can also be nonpalpable.[2] Enlargement of the thyroid is due to lymphocytic infiltration and fibrosis rather than tissue hypertrophy. Physiologically, antibodies against thyroid peroxidase (TPO) and/or thyroglobulin cause gradual destruction of follicles in the thyroid gland. Accordingly, the disease can be detected clinically by looking for these antibodies in the blood. It is also characterized by invasion of the thyroid tissue by leukocytes, mainly T-lymphocytes. It is associated with non-Hodgkin lymphoma.
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