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Thyroid Case: 52-year-old Woman with Weight Gain, Fatigue and Poor Concentration
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Slides Thyroid Disease.pdf
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00:01 A 52 year old woman comes to see you for follow up of her thyroid tests. 00:06 When you last saw her two weeks ago, she complained of weight gain, fatigue and poor concentration On exam, she had a body mass index of 33, a heart rate of 55 beats per minute and her thyroid exam was unremarkable. 00:21 Skin was dry and coarse, and her deep tendon reflexes demonstrated a delayed relaxation phase. 00:29 You ordered a TSH level which is elevated at 24 microunits per mL and subsequently a free T4 which was low. 00:38 Her TPO antibody level is positive. 00:42 What is the next step for today's visit? So let's go through this patient's presentation. 00:49 Signs and symptoms point towards clinical hypothyroidism Remarkably as well, she has elevated TSH. 00:57 The normal range for TSH is 0.4 to 4 microunits per mL In conjunction with this, she also has free T4 level which is low and a thyroid peroxidase antibody level which is positive Putting this all together, it gives the picture of primary hypothyroidism likely due to Hashimoto's thyroiditis and in this appointment, we will commence her on levothyroxine thyroid replacement We made the diagnosis of Hashimoto's thyroiditis in this patient and on today's visit, the discussion should revolve around thyroid hormone replacement initiation The presence of TPO antibodies has suggested that Hashimoto's thyroiditis is the cause Thyroid imaging is not indicated here unless there is a concern for a nodule on physical exam which is suspicious for a malignancy.
About the Lecture
The lecture Thyroid Case: 52-year-old Woman with Weight Gain, Fatigue and Poor Concentration by Michael Lazarus, MD is from the course Thyroid Disorders.
Included Quiz Questions
Which of the following history and physical examination findings is most consistent with hypothyroidism?
- Deep tendon reflexes with delayed relaxation
- Weight loss
- Softening of skin
- Tachycardia
- Abnormal findings on thyroid examination
What is the best next step for a patient with elevated an TSH level and a decreased T4 level?
- Initiate thyroid replacement therapy
- Order pituitary imaging
- Perform ultrasound-guided fine-needle aspiration
- Order CT of the structures of the neck
- Initiate a patient-centered weight loss program
What is the next step in the treatment of the patient described below? A 52-year-old woman presents for follow-up of her thyroid tests. Two weeks ago, she complained of weight gain, fatigue, and poor concentration. Physical examination: BMI of 33 kg/m2, heart rate of 55 beats/min, dry and coarse skin, and deep tendon reflexes demonstrated a delayed relaxation phase. Laboratory test results: elevated TSH level at 24 μU/mL, low free T4, and positive TPO Ab level.
- Begin treatment with levothyroxine
- Order an ultrasonograph of the thyroid
- Order a radioactive iodine uptake test (RIUT)
- Perform fine-needle aspiration
Author of lecture Thyroid Case: 52-year-old Woman with Weight Gain, Fatigue and Poor Concentration
Michael Lazarus, MD
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