Im
HIV - 01-02-08 12:55
A 61-year-old woman presents to her primary care clinic with difficulty breathing and swallowing, as well as throat and neck pain and voice changes over the past two months. She is very sensitive to cold and constantly feels tired. She also has fatty, foul-smelling stools. She denies abdominal pain, vomiting, or weight changes. She has itching, which has increased over the past month, and constantly experiences dryness of the mouth, which is unrelieved by drinking fluids. During the last visit to her gynecologist, she was found to have an immobile, painful, thickened cervix and was diagnosed with sclerosing cervicitis. The diagnosis was supported by cervical biopsy.
On physical examination, her temperature is normal, and the pulse is 62/min. Her face looks slightly puffy, and her skin is dry and pale. There are xanthomatous lesions around the eyelids and on the face. The mucous membranes are dry. The thyroid gland is palpable, enlarged, asymmetrical, hard, and immobile. There is no tenderness on palpation of the thyroid. There is a mild lower extremity edema. Laboratory studies show: sodium 132 mEq/L, potassium 3.4 mEq/L, BUN 24 mg/dL, creatinine 0.9 mg/dL, cholesterol 290 mg/dL, triglycerides 168 mg/dL, TSH 34 mU/L (normal 0.4-5.0 mU/L), and free T4 0.6 ng/dL (normal 0.9-2.4 ng/dL). The thyroid radioiodine uptake is low, and the scan reveals uneven uptake. Antimitochondrial antibodies are present, and thyroid autoantibodies are negative. Thyroid-gland ultrasound reveals diffuse changes, with no nodular structures. An ultrasound-guided, thyroid-gland biopsy reveals an increased amount of fibrotic tissue. What would be the most effective treatment in this thyroid gland disorder?
(A) Surgical decompression
(B) Corticosteroids
(C) Tamoxifen
(D) Levothyroxine
(E) Radiation therapy
HIV - 01-02-08 12:55
A 61-year-old woman presents to her primary care clinic with difficulty breathing and swallowing, as well as throat and neck pain and voice changes over the past two months. She is very sensitive to cold and constantly feels tired. She also has fatty, foul-smelling stools. She denies abdominal pain, vomiting, or weight changes. She has itching, which has increased over the past month, and constantly experiences dryness of the mouth, which is unrelieved by drinking fluids. During the last visit to her gynecologist, she was found to have an immobile, painful, thickened cervix and was diagnosed with sclerosing cervicitis. The diagnosis was supported by cervical biopsy.
On physical examination, her temperature is normal, and the pulse is 62/min. Her face looks slightly puffy, and her skin is dry and pale. There are xanthomatous lesions around the eyelids and on the face. The mucous membranes are dry. The thyroid gland is palpable, enlarged, asymmetrical, hard, and immobile. There is no tenderness on palpation of the thyroid. There is a mild lower extremity edema. Laboratory studies show: sodium 132 mEq/L, potassium 3.4 mEq/L, BUN 24 mg/dL, creatinine 0.9 mg/dL, cholesterol 290 mg/dL, triglycerides 168 mg/dL, TSH 34 mU/L (normal 0.4-5.0 mU/L), and free T4 0.6 ng/dL (normal 0.9-2.4 ng/dL). The thyroid radioiodine uptake is low, and the scan reveals uneven uptake. Antimitochondrial antibodies are present, and thyroid autoantibodies are negative. Thyroid-gland ultrasound reveals diffuse changes, with no nodular structures. An ultrasound-guided, thyroid-gland biopsy reveals an increased amount of fibrotic tissue. What would be the most effective treatment in this thyroid gland disorder?
(A) Surgical decompression
(B) Corticosteroids
(C) Tamoxifen
(D) Levothyroxine
(E) Radiation therapy
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#1
Re: Im TheOne - 01-02-08 15:30 Hashimoto's thyoiditis. So (B) Corticosteroids. Although we should consider surgical decompressionas she have obstructive symptoms.
#4
Re: Im ammulufy - 07-03-10 21:29 Features of dysphagia,voice changes n wt.loss signifies carcinomatous changes in d thyroid gland though radionuclide scanning is not revealing positively towards dat....derfore I wud go for a ie surgical excision.
#5
Re: Im babbu5508 - 07-07-10 00:55 (B) Corticosteroids ...the features are suggestive of hashimotos disease...elevated tsh and depressed t4 s/o hypothyroidism..(D) Levothyroxine may be needed
#6
Re: Im bingousmle - 07-13-10 02:17 the patient is showing signs and symptoms of severe hypothyoidism and thework up is consistent with destruction of thyroid gland so levothyroxine
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