Questions: A 30-year-old woman presents with constipation for the past 4 months. She used to have 2-3 bowel movements per day, but she has only been having a bowel movement every 2 days for the last 4 months. In addition, she complains of feeling cold and fatigued all the time, as well as, gaining 30 pounds in the past year. Her current medications include atorvastatin and Tylenol. The patient denies any pain in her joints, limbs, flank, or bones. She also denies any numbness, tingling, loss of sensation, loss of bowel control, or altered mental status. The patient's temperature is 98.5 degrees Fahrenheit, HR is 60, RR is 12, and BP is 100/60. Physical exam reveals slight bradycardia with no tenderness to palpation anywhere in the body. What is the best step in management after obtaining laboratory results that confirm your suspected diagnosis? A. Administration of levothyroxine (Synthroid) B. Stop current medications C. Laxative administration D. Steroids and interferon-beta

The answer is A: Administration of levothyroxine (Synthroid).

Explanation:

• The symptoms presented by the patient, including constipation, feeling cold, fatigue, weight gain, and bradycardia, are suggestive of hypothyroidism. Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, leading to a slowed metabolism and the symptoms described.

• Option A: Administration of levothyroxine (Synthroid) is the correct choice because levothyroxine is a synthetic thyroid hormone used to treat hypothyroidism. It helps to normalize the levels of thyroid hormones in the body, alleviating the symptoms.

• Option B: Stopping current medications is not appropriate in this case, as the symptoms are not likely caused by atorvastatin or Tylenol. These medications do not typically cause the symptoms described.

• Option C: Laxative administration would address the constipation symptom but would not treat the underlying cause, which is hypothyroidism. It is not the best step in management.

• Option D: Steroids and interferon-beta are not indicated for hypothyroidism. These treatments are used for other conditions, such as autoimmune diseases and multiple sclerosis, respectively.

In summary, the best step in management after confirming the diagnosis of hypothyroidism is to start the patient on levothyroxine (Synthroid) to address the underlying hormonal deficiency.