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NBME 18 Answers

nbme18/Block 3/Question#31 (reveal difficulty score)
28 yo woman, 4 days of palpitations, severe ...
Subacute granulomatous thyroiditis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: endo repeat

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 +5  upvote downvote
submitted by โˆ—sympathetikey(1598)

Self-limited disease often following a flu-like illness (eg, viral infection). May be hyperthyroid early in course, followed by hypothyroidism (permanent in ~15% of cases). Very tender thyroid is seen.

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sympathetikey  Short time course & tenderness was a tip for me. +14
rainlad  Aka de Quervain's thyroiditis +
kcyanide101  the quervian=pain. +1

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submitted by โˆ—an1(114)

so this patient had a very tender thyroid gland.

first start ruling out. no exop was trying to say its not graves. she also had a LOW TSH (indicating it was hyperthyroid ~ recall that many hypothyroid conditions present with primary hyperthyroidism labs).

there wasn't enough to support A here (should have low iodine uptake and low thyroglobulin).

thyroid abscess needed a fever and is just an odd Dx.

Toxic MNG and subacute left.

subacute or de quervains is VERY painful. if you look in the endo section, subacute is actually the ONLY tender condition

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