You have a 2-week-old term infant in your office for a well-child visit. The mother notes that she received a letter from the state’s Department of Health reporting that her child’s newborn screen had come back abnormal, indicating possible congenital hypothyroidism. Your nursing staff has already repeated the laboratory studies, and the child’s TSH is 32 µU/ml (elevated) and the T4 is 0.3µg/dL (low). Which of the following is the most appropriate management at this point?
a. Begin sodium-L-thyroxin, 10 to 15 µg/kg/day
b. Serum for maternal antithyroid antibodies
c. Referral to endocrinology for evaluation
d. 123I-sodium iodine uptake scan
e. Ultrasound of the thyroid gland
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is a; Begin sodium-L-thyroxin, 10 to 15 µg/kg/day.
All 50 states in the United States, as well as most developed countries, screen in the neonatal period infants for congenital hypothyroidism. Identified and treated early, most affected children will have normal growth and intelligence. Untreated, the outcome of congenital hypothyroidism is mental retardation and poor growth (cretinism). Early treatment is essential, and should not be delayed while arranging further diagnostic evaluation. Approximately 85% of all cases of congenital hypothyroidism are a result of thyroid dysgenesis, generally a sporadic event. A 123I-sodium iodine uptake scan can help identify the underlying cause, but treatment should not be withheld pending the outcome of this or any other study after initial confirmation.