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Discontinue atorvastatin
23%
17/74
Coenzyme Q10
1%
1/74
TSH level
69%
51/74
Aldolase level
3%
2/74
Muscle biopsy
Select Answer to see Preferred Response
This patient is presenting with fatigue, muscle weakness, constipation, and sluggish reflexes suggesting a diagnosis of hypothyroid myopathy. The next best step in management is to check a TSH and T4 level to confirm the diagnosis. Hypothyroid myopathy presents with fatigue, myalgias, sluggish reflexes, proximal muscle weakness, and an elevated creatine kinase as well as other symptoms of hypothyroidism such as depression, constipation, and thinning hair. The best next step in management is to obtain a TSH and T4 level to confirm the diagnosis. Treatment should then be started with thyroxine which treats the underlying cause. Incorrect Answers: Answers 1-2: Discontinue atorvastatin and administer coenzyme Q10 (CoQ10) would be appropriate if the suspected diagnosis was statin-induced myopathy. Typically, starting CoQ10 and taking statin medications at night would be sufficient for patients who experience statin-induced myopathy. Answer 4: Checking an aldolase level would be appropriate if the suspected diagnosis is polymyositis or dermatomyositis. Though these pathologies would present with muscle weakness, the other findings seen in this patient are more suggestive of hypothyroidism. Answer 5: Muscle biopsy is the most accurate test for polymyositis/dermatomyositis but would not be indicated prior to other less invasive laboratory tests. Bullet Summary: The best initial diagnostic test for hypothyroid myopathy is a serum TSH and T4 level.
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