endo 2 - darkhorse - Printable Version +- USMLE Forum - Largest USMLE Community (https://www.usmleforum.com) +-- Forum: USMLE Forum (https://www.usmleforum.com/forumdisplay.php?fid=1) +--- Forum: Step 2 CK (https://www.usmleforum.com/forumdisplay.php?fid=3) +--- Thread: endo 2 - darkhorse (/showthread.php?tid=252277) |
endo 2 - darkhorse - ArchivalUser - 12-16-2007 A 40-year-old female complains of low-grade fevers and anterior neck pain for 6 days. She denies tremor, weight loss, or visual changes. Examination shows a tender and slightly enlarged thyroid gland. There is no bruit. The rest of the examination is unremarkable. TSH is low. T4 and T3 are both elevated. A radionuclide scan shows low uptake. Anti-TPO antibodies are negative. What would be the most appropriate therapy at this point? A. Radioiodine ablation B. Methimazole C. Prednisone D. Levothyroxine E. Surgery 0 - ArchivalUser - 12-16-2007 c. 0 - ArchivalUser - 12-16-2007 is it prednisone for hashimoto. i was thinking of D. 0 - ArchivalUser - 12-16-2007 c. 0 - ArchivalUser - 12-16-2007 4 subacute: asa, prednisone, propanolol 0 - ArchivalUser - 12-16-2007 Painful thyroiditis- usually dequervains- low radio i uptake and raised t4 , low TSH- all favour this. prednisolone to reduce inflammation, painkillers, symptomatic tratment with beta blockers 0 - ArchivalUser - 12-16-2007 The answer is C. This patient's history is most consistent with the thyrotoxic phase of subacute thyroiditis. The peak incidence occurs between ages 30 and 50. The etiology is usually viral. There is a significant female predominance. The low uptake on a radionuclide scan in the setting of a recent onset of a painful thyroid clearly points to subacute thyroiditis. Elevation in T4 and T3 points to the thyrotoxic phase rather than the hypothyroid phase. The patient would be expected to improve over the course of months, and so permanent ablation with radioiodine or surgery is inappropriate. Antithyroid medications such as methimazole and propylthiouracil (PTU) have no role because the pathophysiology of thyroiditis relates to destruction of the gland and hormonal release, not hyperactivity, as in the case of Graves' disease and multinodular goiter. Levothyroxine may play a role in the hypothyroid phase, but not while the patient is acutely thyrotoxic. Anti-inflammatory medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids are most appropriate. Beta blockers would be appropriate if the patient were having more symptoms of thyrotoxicosis. |