A 27-year-old woman is evaluated for palp 29 - highsky

[ArchivalUser]

A 27-year-old woman is evaluated for palpitations and heat intolerance that develop 3 months after a successful pregnancy. She is breastfeeding. The patient's older sister has Graves' disease, but the patient herself has no history of thyroid disease.

On physical examination, the blood pressure is 128/70 mm Hg, and the pulse rate is 104/min. Eye examination reveals stare and lid lag, but no proptosis. The thyroid gland is moderately enlarged and nontender. She has moist palms and brisk deep tendon reflexes. Serum free T4 is 2.7 ng/dL (34.2 pmol/L), free T3 46.22 ng/dL (7.1 pmol/L), and thyroid-stimulating hormone (TSH) is undetectable.

Which one of the following is the most appropriate next step in this patient's management?

A Serum anti-thyroid peroxidase antibodies
B Serum thyroglobulin level
C Serum TSH immunoglobulins
] D An empiric trial of antithyroid drugs
E Radioiodine (I-131) uptake and thyroid scan

[ArchivalUser]

ee?

[ArchivalUser]

ee

[ArchivalUser]

EE ? SHE IS BREAST FEEDING.

[ArchivalUser]

ee

[ArchivalUser]

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[ArchivalUser]

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[ArchivalUser]

(Correct Answer = C)

Measurement of TSH-receptor autoantibodies, which are present in more than 90% of patients with Graves' disease but are not present in postpartum thyroiditis, can distinguish between the two disorders in a patient with postpregnancy thyrotoxicosis.

This woman has developed thyrotoxicosis after pregnancy. The primary diagnostic distinction to be made is between postpartum thyroiditis and Graves' disease. TSH-receptor autoantibodies are present in more than 90% of patients with Graves' disease but are not present in patients with postpartum thyroiditis. Measurement of serum anti-thyroid peroxidase antibodies and serum thyroglobulin levels do not distinguish between Graves' disease and postpartum thyroiditis. Anti-thyroid peroxidase antibodies will likely be positive in both disorders, and serum thyroglobulin levels are elevated in both disorders. Antithyroid drugs are better reserved for confirmed Graves' disease in this setting, and that diagnosis has not been made. Radioiodine uptake will be low in thyroiditis and elevated in Graves' disease; however, radioiodine is secreted into breast milk, and the isotope most commonly used to measure radioiodine uptake (131I) has such a prolonged duration of activity that further breastfeeding is precluded.

[ArchivalUser]

E WILL BE THE ANS. IF NOT PREG OR BRST FEEDING.