05-13-2009, 03:48 PM
A 35 year old woman comes to the ER complaining of palpitations . An EKG shows A FIb. She says that she has NEVER experienced this before and has never been diagnosed like this before. You as the resident examine her -irregularly irregularpulse, a diffuse swelling in her neck. SHe has a pronounced stare as if her eyes are popping out. She also gives history of feeling hot and sweaty and easy arousability. The labs show her TSH level as <0.1 mu/ml (normal: 0.5-5) and free T4 as 6 ng/dl (N = 0.8 to 2). You find her hyperthyroid and remember your endocrine class that U diffuse enlargement with hyperthyroidism can be due to Graves disease and sub acute thyroiditis. As the examination was confusing for you, you call the endocrinologist. The Most likely advice from the endocrinologist will be:
a). Close observation
b). Start propyl thio uracil and propranolol
c). 24 hour radioactive iodine uptake scan
d). Start methimazole and also send her for radio iodine ablation now
e). Reassurance only
a). Close observation
b). Start propyl thio uracil and propranolol
c). 24 hour radioactive iodine uptake scan
d). Start methimazole and also send her for radio iodine ablation now
e). Reassurance only