45 year old female evaluated for fatigue. She denies sleep disturbances, appetite, weight, mood and bowel habit changes. Physical examination and vital signs are unremarkable. Neck exam, visual field assessment and skin examination are normal. Na=133 TSH=14 T4=7.2. What is the next step?
سؤال مجاني 3 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
المصادر مختلفة. ملفات الدفعة فيها إجابتين، وما نرجّح وحدة على الثانية. سبب كل وحدة في الشرح تحت:
- إجابة: A. Start levo thyroxine tablets for primary hypothyroidism
- إجابة ثانية: D. Arrange for US and request T3 and TPO ab
TSH 14 with a normal T4 is subclinical hypothyroidism. The cohort's sources list TSH > 10 as an indication to treat with levothyroxine, even without symptoms or goiter. So option A is best supported, although its label 'primary hypothyroidism' is loose (it is subclinical primary thyroid failure). The old bank key D (US + T3 + TPO antibodies) is weaker: a neck US is not needed with a normal neck exam, and T3 adds nothing in hypothyroidism. Positive TPO antibodies are only a separate reason to treat when TSH is below 10. Carbimazole and a pituitary panel do not fit a high TSH.
ليش كل خيار صح أو غلط
-
A
ليش صح
Supported by the Endocrine summary (and Hypothyroidism Notes): subclinical hypothyroidism (high TSH, normal T4) is treated when TSH is greater than 10; here TSH is 14. Option D is defended by a different source.
✓ Endocrine ✳️.pdf · p. 14 -
B
ليش غلط
Carbimazole is an antithyroid drug for hyperthyroidism; a high TSH (14) with a normal T4 is low thyroid function, not hyperthyroidism.
✓ Endocrine ✳️.pdf · p. 12 -
C
ليش غلط
A pituitary hormone panel is for secondary or tertiary hypothyroidism, where TSH is low; this patient's TSH is high (14).
✓ Step Up To Medicine 6th Edition 2024 (Thyroid).pdf · p. 9 -
D
ليش صح
Supported by Step Up, which lists raised TPO antibodies (Hashimoto thyroiditis) among the lab findings of hypothyroidism. The Endocrine summary and Hypothyroidism Notes instead point to treating at TSH above 10 (option A).
✓ Step Up To Medicine 6th Edition 2024 (Thyroid).pdf · p. 9
- المصدر
- Endocrine ✳️.pdf · p. 14
Step Up To Medicine 6th Edition 2024 (Thyroid).pdf · p. 9
1• Hypothyroidism [Notes].pdf · p. 8 - المحاضرة
- Thyroid Disorders · Endocrinology · Module B
- ظهر في
- Endo bank