A 48-year-old woman is brought to the emergency department by her family at her psychiatrist's recommendation. According to her family, she has been more restless than her baseline over the past week. The patient herself complains that she feels her mind is racing. Her past medical history is significant for bipolar disorder on lithium and type 1 diabetes mellitus. The family and the patient both assert that the patient has been taking her medications. She denies any recent illness or sick contacts. The patient's temperature is 100°F (37.8°C), blood pressure is 100/60 mmHg, pulse is 130/min, and respirations are 20/min. She appears diaphoretic, and her cardiac exam is notable for an irregularly irregular rhythm with a 2/6 early systolic murmur. Blood counts and metabolic panel are within normal limits. The patient's lithium level is within therapeutic range. Which of the following laboratory tests would be the most useful to include in the evaluation of this patient?
AThyroglobulin level
BThyroid stimulating hormone and total thyroxine levels
CThyrotropin-releasing hormone stimulation test
DTriiodothyronine and thyroxine levels
EThyroid stimulating hormone and free thyroxine levels
A 27-year-old G1P0 at 12 weeks estimated gestational age presents for prenatal care. The patient says she has occasional nausea and vomiting and a few episodes of palpitations and diarrhea this last week. Physical examination is unremarkable, except for a heart rate of 145/min. Basic thyroid function tests are shown in the table below. Which of the following additional laboratory tests would be most useful in assessing this patient's condition? Thyroid-stimulating hormone (TSH) 0.28 mIU/L (0.3–4.5 mIU/L) Total T4 12 µg/dL (5.4–11.5 µg/dL)
AThyrotropin receptor antibodies (TRAb)
BTotal triiodothyronine (T3) levels
CThyroid peroxidase (TPO) antibodies
DFree thyroxine (T4) levels
EThyroxine-binding globulin (TBG) levels
A 39-year-old female presents to the clinic with the complaints of dry skin for a few months. She adds that she also has constipation for which she started eating vegetables and fruits but with no improvement. She lives with her husband and children who often complain when she turns the air conditioning to high as she cannot tolerate low temperatures. She has gained 5 kgs (11.2 lb) since her last visit 2 months back although her diet has not changed much. Her past medical history is relevant for cardiac arrhythmias and diabetes. She is on several medications currently. Her temperature is 98.6° F (37° C), respirations are 15/min, pulse is 57/min and blood pressure is 132/98 mm Hg. A physical examination is within normal limits. Thyroid function test results are given below: Serum TSH: 13.0 μU/mL Thyroxine (T4): 3.0 μg/dL Triiodothyronine (T3): 100 ng/dL Which of the following medications is most likely to be responsible for her symptoms?
AAmiodarone
BDigoxin
CMetformin
DTheophylline
EWarfarin
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