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 Best of Five 2.70

 

   

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BOF: 2.70

A 53-year-old female who was on amiodarone presents with weight loss despite a good appetite, heat intolerance, tremors and excessive sweating.

On examination she has exophthalmos and a palpable goitre. Pulse rate was 120 beats per minute regular and she had a fine tremor of her hands

Thyroid function tests showed the following values: thyroid stimulating hormone (TSH), < 0.03 mIU/L (normal, 0.5-5.0 mIU/L); thyroxine (T4), 15.3 µg/dL (normal, 4.0-10.5 µg/dL); triiodothyronine (T3), 256 ng/dL (normal, 80-200 ng/dL); free thyroxine index (FT4I), 19.4 (normal, 4.7-10.0). She was positive for thyroid peroxidase (“microsomal”) antibodies, and thyroid stimulating immunoglobulin.

In this patient the most suitable initial treatment would be a combination of:

a) Steroids and azathioprine

b) Carbimazole and radioactive iodine

c) Potassium perchlorate and carbimazole

d) Carbimazole and surgery

e) Steroids and carbimazole

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