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Old 09-20-2012
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I agree Hypothtyroidism

65 Year old woman is recently diagnosed with hypothyroidism.The patient has a past medical history of hypertension, diabetes mellitus and hyperlipidemia. She is started on high dose levothyroxine.
Which of the following is the most dangerous complication of therapy ?

A. Angina
B. Hypertensive crisis
C. Hypoglycemia
D. Myocardial Infarction
E. Seizures
F. Worsening of glucose control
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Old 09-20-2012
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ans ............B..........
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Old 09-20-2012
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MOST dangerous of these choices is an MI.
However she also has Hypertension.. and probably IN THIS patient hypertensive crisis is more likely.. I would put B but considering MI close second..

Also if we consider she has 4 different equivalents of atherosclerotic disease...(why 4 you may ask.. well for me she is an obese fat ass until proven otherwise) MI can also happen
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Old 09-20-2012
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the debate about starting treatment for sub clinical hypo and who to treat focuses on the fact that in can accelerate athero
that is you ans
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Old 09-20-2012
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B. Hypertensive crisis

The features are same as hyperthyroidism in which there is systolic hypertension secondary to hyperdynamic circulation (increased CO) as well as increased sensitivity of adrenergic receptors to catecholamines.
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Old 09-20-2012
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D. Myocardial infarction.
Inc risk of MI especially with the initiation of thyroxin, as rate of metabolism would increase thus increasing myocardial oxygen demand.
In diabetic pts, many times MI is usually silent, so this pt might first present with MI without any complaint of chest pain.
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Old 09-21-2012
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Answer D Myocardial Infarction

Cardiac metabolic rate is controlled by thyroid hormone levels. If the level is increased too high, it can precipitate a myocardial infarction .This part is the same reason that those with hypothyroidism and coronary artery disease experience less angina symptoms. Thyroxin increases metabolic demands of tissues as well as the oxygen consumption.Replacing thyroxine at high doses increase amount of myocardial work.
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