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A 75-Year-Old Woman Is Seen in Consultation Prior to Hip

question 799

Multiple Choice

A 75-year-old woman is seen in consultation prior to hip surgery. She fell on icy ground 36 hours ago and sustained an intertrochanteric right hip fracture. The patient lives independently. Her other medical problems include hypertension, osteoporosis, type 2 diabetes mellitus, and mild cognitive impairment.
Her right lower extremity is shortened and externally rotated, but physical examination is otherwise unremarkable.
Records indicate that her primary care provider obtained thyroid function tests a month ago as part of an evaluation for hypertension that showed the following:
$A 75-year-old woman is seen in consultation prior to hip surgery. She fell on icy ground 36 hours ago and sustained an intertrochanteric right hip fracture. The patient lives independently. Her other medical problems include hypertension, osteoporosis, type 2 diabetes mellitus, and mild cognitive impairment. Her right lower extremity is shortened and externally rotated, but physical examination is otherwise unremarkable. Records indicate that her primary care provider obtained thyroid function tests a month ago as part of an evaluation for hypertension that showed the following: Her current laboratory results are as follows: Which of the following is the most appropriate next step in management of this patient? A) Delay surgery and start oral levothyroxine B) Delay surgery until results of cortisol, free T<sub>4</sub>, and repeat TSH return C) Give intravenous thyroxine and hydrocortisone and proceed with surgery D) Give intravenous thyroxine and proceed with surgery E) Proceed with surgery$
Her current laboratory results are as follows:
$A 75-year-old woman is seen in consultation prior to hip surgery. She fell on icy ground 36 hours ago and sustained an intertrochanteric right hip fracture. The patient lives independently. Her other medical problems include hypertension, osteoporosis, type 2 diabetes mellitus, and mild cognitive impairment. Her right lower extremity is shortened and externally rotated, but physical examination is otherwise unremarkable. Records indicate that her primary care provider obtained thyroid function tests a month ago as part of an evaluation for hypertension that showed the following: Her current laboratory results are as follows: Which of the following is the most appropriate next step in management of this patient? A) Delay surgery and start oral levothyroxine B) Delay surgery until results of cortisol, free T<sub>4</sub>, and repeat TSH return C) Give intravenous thyroxine and hydrocortisone and proceed with surgery D) Give intravenous thyroxine and proceed with surgery E) Proceed with surgery$
Which of the following is the most appropriate next step in management of this patient?

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