A 74-Year-Old Man Is Brought to the Emergency Department After

question 1039

Multiple Choice

A 74-year-old man is brought to the emergency department after being found outside early on New Year's morning.  His medical history is unknown.  Temperature is 31.5 C (88.7 F) , blood pressure is 75/50 mm Hg, pulse is 55/min, and respirations are 8/min and shallow.  On examination, the patient is unresponsive.  Initial laboratory results are as follows: Blood alcohol level is undetectable and urine drug screen is negative.  Plasma cortisol and ACTH levels are normal.  Chest x-ray reveals a right lower lobe infiltrate.  The patient is placed on mechanical ventilation, pressor support, warm intravenous fluids, and broad-spectrum antibiotics.  Blood cultures are pending.  His vital signs improve rapidly with rewarming.  Which of the following is the best next step in management of this patient's thyroid abnormalities?

• A)Assay for antithyroid peroxidase antibody
• B)Measure reverse T3 level
• C)Repeat thyroid function tests in 8 weeks
• D)Start levothyroxine (T4) therapy
• E)Start liothyronine (T3) therapy

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