[mtoi]

INPATIENT/ ER/ CLINIC/ OTHER - clinic
PATIENT PROFILE - 29 yo white female, recent onset of fever and throat pain, bp 110/70, pulse 90, physical exam unremarkable
RELEVANT HX - hyperthyroidism controlled with medical therapy
QUESTION - what should be the next step?

A TSH and T4/T3
B ESR and anti-neutrophil antibodies
C WBC count with differential
D empirical oral antibiotics
E ibuprofen and oral hydration

:notsurelease support your answer with explanation:notsure:

 

[mtoi]

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WBC count with differential secondary to hematological side effects
PTU and methimazole are available in usa, both belong to thioamide class
Thioamides act at the following steps (of thyroid hormone synthesis)
Organification by peroxidase
Iodination of tyrosyl residues on thyroglobulin to form MIT and DIT
Coupling reactions to form DIT, T3, and T4
Hematologic side effects: Agranulocytosis, aplastic anemia, granulocytopenia, hypoprothrombinemia, leukopenia, thrombocytopenia