QuestionSBA
QuestionChoice
This patient hasn't been taking her levothyroxine medication as intended. This can be inferred due to the blood results in the investigations section of this question. She therefore doesn't need her levothyroxine dose adjusting and instead requires counselling on the importance of taking her levothyroxine as prescribed.
50448
e
Increase this patients levothyroxine to 125 micrograms PO OD
QuestionChoice
This patient hasn't been taking her levothyroxine medication as intended. This can be inferred due to the blood results in the investigations section of this question. She therefore doesn't need her levothyroxine dose adjusting and instead requires counselling on the importance of taking her levothyroxine as prescribed.
50445
b
Increase this patients levothyroxine to 100 micrograms PO OD
QuestionChoice
This patient hasn't been taking her levothyroxine medication as intended as indicated by the normal T3/T4 level and raised TSH. This can be inferred due to the blood results in the investigations section of this question. She therefore doesn't need her levothyroxine dose adjusting and instead requires counselling on the importance of taking her levothyroxine as prescribed.
50444
a
Make no changes to her medication
QuestionChoice
This patient hasn't been taking her levothyroxine medication as intended. This can be inferred due to the blood results in the investigations section of this question. She therefore doesn't need her levothyroxine dose adjusting and instead requires counselling on the importance of taking her levothyroxine as prescribed.
50446
c
Decrease this patients levothyroxine to 50 micrograms PO OD
QuestionChoice
This patient hasn't been taking her levothyroxine medication as intended. This can be inferred due to the blood results in the investigations section of this question. She therefore doesn't need her levothyroxine dose adjusting and instead requires counselling on the importance of taking her levothyroxine as prescribed.
50447
d
Decrease this patients levothyroxine to 25 micrograms PO OD
QuestionComment
Should you not continue levothyroxine replacement until TSH also normalises? or does this take a longer period of time?
61451
User
subscriber
Edema Womb
QuestionComment
Could someone explain how we deduce that the patient isnt taking her levothyroxine? 
61782
QuestionComment
It's that her T3 and T4 are normal with a raised TSH. TSH should also be within normal range if she were taking her levothyroxine as instructed
61816
User
subscriber
Monoclonal Myopathy
User
subscriber
Simple squamous cell
QuestionComment
There's a section on subclinical hypothyroidism if you type in the hypothyroidism treatment summary -> management of primary hypothyroidism
61875
User
subscriber
lil' aneurysm
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3672
Thyroid function tests when a patient is not taking their medication properly
Topic
9
Internal Medicine
10143
Case Presentation: A 33-year-old female attends her GP to review her blood tests.




 **PMH** Hypothyroidism


 **DH** Levothyroxine 75 micrograms PO OD


 **Investigations**


||||
|---------------------------|:-------:|------------------------------|
|Thyroid Stimulating Hormone|9.8 mU/L|0.3 - 4.2|
|Free T4|21 pmol/L|9 - 25|
|Free T3|5 pmol/L|3.1 - 6.8|




Question: Select the most appropriate decision option based on this data.
a