A -year-old male comes to the clinic for follow-up of recent fatigue, severe heat intolerance, and an unintentional weight loss of () over the last month. His medical history is significant for ischemic cardiomyopathy with a reduced ejection fraction and recurrent sustained ventricular tachycardia. His medications include sacubitril-valsartan, metoprolol succinate, spironolactone, and amiodarone, which he has taken for two years. Vital signs show a temperature of (), a blood pressure of , and an irregular pulse of . Physical examination reveals warm, moist skin and a fine bilateral hand tremor. No goiter or exophthalmos is noted.
Laboratory results are as follows:
Thyroid-stimulating hormone (TSH): (Normal: )
Free T4: (Normal: )
Free T3: (Normal: )
Color flow Doppler ultrasonography of the thyroid gland demonstrates severely decreased vascularity.
Which of the following is the most appropriate next step in the management of this patient's thyroid dysfunction?
- AInitiate oral methimazole
- BDiscontinue amiodarone and reevaluate in 4 weeks
- CAdminister saturated solution of potassium iodide
- Initiate oral prednisoneAnswer
- ERefer for radioactive iodine ablation