Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Inform the patient that she likely has a viral infection and discharge her home with supportive care.
20%
17/86
Initiate antibiotic therapy for presumed Streptococcal pharyngitis.
1%
1/86
Obtain a complete blood count.
65%
56/86
Obtain a thyroid stimulating hormone level.
10%
9/86
Consult an endocrinologist.
0%
0/86
Select Answer to see Preferred Response
This patient with Graves' disease is likely on methimazole or PTU. A potential side effect of this medication is agranulocytosis and thus a CBC is the next step in management. Graves' disease is the most common cause of hyperthyroidism. An autoimmune process causes production of anti-TSH receptor antibodies. Patients are most commonly female and present in times of stress such as childbirth and infection. Symptoms include the classic features of hyperthyroidism, such as heat intolerance, weight loss, diarrhea, tachycardia, and sweating. Treatment centers on beta blockers, iodine-131 ablation, and thionamides such as PTU and methimazole. Each of these medications is associated with agranulocytosis. Generally a patient on PTU or methimazole who has agranulocytosis will present with sore throat and fever (with a severely diminised WBC count). Thus, any patient with Graves' disease receiving pharmacotherapy should obtain a CBC when presenting with sore throat and fever. Reid et al. discuss the diagnosis and treatment of hyperthyroidism. The most common cause of hyperthyroidism is Graves' disease. Other common causes include thyroiditis, toxic multinodular goiter, toxic adenomas, and side effects of certain medications. The diagnostic workup begins with a thyroid-stimulating hormone level test. Mutharasan et al. describe delayed antithyroid drug-induced agranulocytosis. Agranulocytosis may present long after the initiation of drug therapy. Thus, it is important to remain aware of signs of agranulocytosis throughout the course of treatment, even after years. Illustration A depicts a patient with Graves' ophthalmopathy. Incorrect Answers: Answer 1: This may just be rhinovirus; however, given the patient's history of Graves' disease and the risk of agranulocytosis from antithyroid medications, one must rule out lymphopenia and a more serious infection. Answer 2: There are no exudates, lowering the probability of a streptococcal pharyngitits. Moreover, antibiotics should never be started without doing a rapid strep test and obtaining cultures first. Answer 4: Obtaining a TSH would not be wrong given the patient's history of Graves' disease. However, given the patient's symptoms of fever and sore throat, agranulocytosis is the more immediate concern, and thus obtaining a TSH is not the best answer. Answer 5: Obtaining a consult at this point is not necessary. A PCP should first obtain a CBC.
4.6
(7)
Please Login to add comment