An 80-year-old female presents in winter with hypothermia, bradycardia, periorbital edema, and obtundation. TSH is 85 mIU/L with undetectable free T4. What is the initial treatment?
Answer and explanation
Correct answer: C. Intravenous hydrocortisone followed by levothyroxine
- Step 1: Severe decompensated hypothyroidism presenting with hypothermia, altered sensorium, and hemodynamic depression defines myxedema coma.
- Step 2: Management mandates prompt administration of intravenous hydrocortisone prior to or concurrently with intravenous levothyroxine to prevent precipitating an acute addisonian crisis in patients with coexisting adrenal insufficiency.
Answer
Intravenous hydrocortisone followed by levothyroxine.
Why not the others: Propylthiouracil suppresses thyroid hormone production and would be harmful in profound hypothyroidism. Beta-blockers would exacerbate severe bradycardia and cardiovascular collapse. Rapid active external warming causes peripheral vasodilation and shock.
Practise more Endocrine, Renal and Gastrointestinal Pathology.
Free questions with an explanation for every one, and full timed DHA Dubai mock tests.
More Endocrine, Renal and Gastrointestinal Pathology questions
- A 48-year-old female presents with profound polyuria, polydipsia, weight loss, and recurrent candidal vulvovaginitis. Fasting plasma glucose…
- A 32-year-old female presents with palpitations, heat intolerance, diaphoresis, and noticeable anterior neck fullness. Physical examination…
- A 24-year-old female with Type 1 diabetes is brought to the emergency department with altered mental status, tachypnea with fruity breath od…
- A 54-year-old male presents with facial rounding ('moon facies'), proximal muscle weakness, purple abdominal striae, and newly diagnosed hyp…
- A 63-year-old male with long-standing poorly controlled diabetes and hypertension presents for evaluation. Laboratory results reveal serum c…
- A 38-year-old male with a history of recurrent calcium oxalate nephrolithiasis undergoes metabolic workup. Laboratory results show hypercalc…