normal T4 with elevated TSH...next step ? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     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 06-12-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 585 Times in 354 Posts
Reputation: 595
Thyroid normal T4 with elevated TSH...next step ?

A 68-year-old woman presents to your office complaining of
feeling tired for the past 3 months. Before that, she had been in
her usual state of health. She also noticed that she has difficulty
moving. She claims that she was afraid to come to the doctor
sooner because she did not want to hear the words, "You're
getting older!" She has no past medical history and uses no
medications. Her blood pressure is 120/70 mm Hg, and her heart
rate is 56/min. The neck examination is normal. Laboratory
studies reveal: sodium 130 mEq/L, potassium 3.6 mEq/L, BUN 11
mg/dL, creatinine 0.9 mg/dL, cholesterol 230 mg/dL, HDL 35
mg/dL, triglycerides 200 mg/dL, hematocrit 32%, and mean
corpuscular volume 97 μm 3
. Her thyroid-stimulating hormone
(TSH) level is 20.2 mU/L (normal 0.4-5.0 mU/L), and free T4 is 1.4
ng/dL (normal 0.4-5.0 ng/dL). What is the next best step in the
management of this patient?

(A) Repeat TSH and free T4 levels in 1 month
(B) Check for thyroid antibodies
(C) Start the patient on methimazole
(D) Start the patient on levothyroxine
(E) Initiate an anemia evaluation
Reply With Quote Quick reply to this message
The above post was thanked by:
neoeinstein (06-12-2012)



  #2  
Old 06-12-2012
K06100's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 730
Threads: 90
Thanked 456 Times in 289 Posts
Reputation: 466
Default

B........??????
__________________
Try Not To Become A Man Of Success But A Man Of Value.
Reply With Quote Quick reply to this message
  #3  
Old 06-12-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 90
Threads: 2
Thanked 68 Times in 30 Posts
Reputation: 78
Default

I think the pt has subclinical hypothyroidism that causes anemia. so il choose
D.
Maybe if the TSH is slightly lower, ill choose A.
Reply With Quote Quick reply to this message
  #4  
Old 06-13-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 585 Times in 354 Posts
Reputation: 595
Default

Quote:
Originally Posted by stimur12 View Post
it is really awesome and a great ability
lolZ. whats so awesome?

and please give ur expln. lets discuss so that we wont do it wrong in ck and with our patients.
Reply With Quote Quick reply to this message



Reply

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

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
epigastric pain+normal endoscopy->next step ? tyagee USMLE Step 2 CK Forum 7 05-31-2012 07:23 PM
Elevated VMA, what's the best next step? drnrpatel USMLE Step 2 CK Forum 3 10-19-2011 07:51 AM
what can cause elevated TSH but normal T3 and T4? saintdizzy USMLE Step 1 Forum 1 10-10-2011 11:10 PM
Thyroid Nodule; T4 and TSH Normal; What is the next step? only2junk USMLE Step 2 CK Forum 6 04-21-2011 06:55 PM
Elevated Dolichol! amnios USMLE Step 1 Forum 2 05-04-2010 08:50 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

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