Thyroid Disorders USMLE Step 1 Practice Question
A 38-year-old woman with untreated Graves disease presents with high fever (40.2°C), severe tachycardia (HR 158), altered mental status, and tremor. She admits to stopping her antithyroid medication 2 weeks ago. TSH is suppressed, free T4 is markedly elevated at 32 pg/dL, and she has signs of dehydration and hypotension. Which of the following is the most appropriate initial treatment?
Answer choices
- AImmediate radioactive iodine ablation
- BHigh-dose levothyroxine to normalize free T4
- CTotal thyroidectomy under general anesthesia
- DIV fluids, propranolol, PTU, iodine solution (Lugol or SSKI), and supportive careCorrect answer
- EAcetaminophen and observation for spontaneous recovery
- FMethimazole monotherapy with close outpatient follow-up
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