A 23-Year-Old Woman Comes to the Office Due to Palpitations

question 783

Multiple Choice

A 23-year-old woman comes to the office due to palpitations, increased frequency of bowel movements, and a 4.5-kg (10-lb) weight loss despite adequate food intake.  The patient's symptoms also include redness of the eyes associated with tearing, grittiness, and photophobia, as well as intermittent diplopia when reading or watching television.  Medical history is unremarkable; she has never been pregnant.  The patient is not sexually active.  She has smoked half a pack of cigarettes a day for the last 2 years.
Blood pressure is 138/66 mm Hg and pulse is 110/min and regular.  The patient appears anxious.  The thyroid gland shows diffuse symmetrical enlargement without tenderness.  A thyroid bruit is audible.  Ocular examination shows bilateral proptosis with conjunctival injection and periorbital edema.
Laboratory evaluation shows a serum TSH level of 0.005 μU/mL and a free thyroxine level of 4.1 ng/dL (normal: 0.9-2.4) .  Thyroid scintigraphy shows 24-hour radioactive iodine uptake of 56% (normal: 10%-30%) with a diffuse pattern.
The patient is started on a beta blocker and oral prednisone.  Which of the following additional interventions should be initiated at this time?

• A)Methimazole
• B)Propylthiouracil
• C)Radioactive iodine
• D)Selenium
• E)Thyroidectomy

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Definitions:

Cultural Identity

The feeling of belonging to a group that shares common cultural traits, such as traditions, language, values, or regional culture.

Idiographic Perspective

An approach focusing on the unique aspects of individuals, emphasizing personal experiences and differences.

Monolithic

Describing an organization, system, or structure that is large, powerful, indivisible, and unwilling to change.

Clinician's Obligation

The ethical and professional responsibility of healthcare providers to deliver care, maintain patient confidentiality, and promote the well-being of their patients.