A 29-Year-Old Woman with Type 1 Diabetes Mellitus Comes to the Office

question 421

Multiple Choice

A 29-year-old woman with type 1 diabetes mellitus comes to the office due to increasing fatigue and irritability.  The symptoms started 2 weeks after the patient developed an upper respiratory infection.  The cough and rhinorrhea have improved, but she continues to have fatigue and has lost 7 kg (15.43 lb) over the past month.  The patient had an uncomplicated delivery 2 months ago and is exclusively formula-feeding her infant.  Blood pressure is 148/72 mm Hg, pulse is 98/min, and respirations are 16/min.  BMI is 26 kg/m².  The thyroid is symmetrically enlarged and nontender.  Cardiopulmonary examination is unremarkable.  The abdomen is soft and nontender.  A hand tremor is present.  TSH level is low, and free T3 and T4 levels are high.  There is low uptake on a radioactive iodine uptake scan.  Which of the following is the most likely cause of this patient's symptoms?

• A)Exogenous thyroid ingestion
• B)Graves disease
• C)Nonthyroidal illness (euthyroid sick syndrome)
• D)Postpartum thyroiditis
• E)Subacute granulomatous thyroiditis

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Definitions:

Percentage

A mathematical term describing a number or ratio expressed as a fraction of 100.

Outside Authority

A source of influence or control that is external to oneself or one's immediate environment.

Authoritarian

A governing or leadership style characterized by absolute or blind obedience to authority, often at the expense of personal freedom.

Right Decisions

Choices or judgments that lead to the most positive outcome based on ethical, practical, or personal considerations.