Step II Kaplan Qbank Q hyperthyroidism

[teehees]

just wanted to clarify this Kaplan Q.

1st step for hyperthyroidism is Thyroid stimulating antibodies right? Thats less invasive then giving a RAIU scan.

 

[dfib slim]

UpToDate recommends measurement of thyrotropin receptor antibodies prior to determination of the radioactive iodine uptake for a nonpregnant hyperthyroid patient without a nodular thyroid and without obvious clinical manifestations of Graves’ disease (eg, without ophthalmopathy).

Was that question last updated in 2010?

 

[teehees]

2013 I think it was. Did you get that from uptodate? I had a look and it seems to say to me either raiu or tsi antibodies are both acceptable first line options depending upon expertise and experience.

 

[Code Blah]

The point of the question is you can't just jump to the diagnosis without ruling out other likely causes. In this case, you need to consider, 'could it be a toxic nodule, multiple toxic nodules, or graves?' By choosing B, you're basically betting it's graves. While that is the most likely scenario, the best test is still radioactive iodine uptake. If it shows one area light up, its toxic nodule. If it shows multiple nodule lighting up, its toxic multinodular goiter. If whole thyroid lights up, it's graves, and you can confirm with the antibodies.

As for the physical exam showing mild enlargement, with no focal nodules; you can't use that to rule out toxic nodule or toxic multinodular goiter, especially the multinodular goiter, as it can feel just like this. Plus nodules < 1 cm simply can't be palpated.