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Delirium — USMLE Step 3 MCQ

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HardPsychiatry (outpatient management)DeliriumUSMLE Step 3

A 42-year-old with bipolar I disorder remains stable on lithium. She has fatigue and cold intolerance; TSH is elevated and free thyroxine is low. Her lithium concentration and kidney function are therapeutic. What is the best management?

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Correct answer: D — Treat hypothyroidism and continue lithium with renal and thyroid monitoring

Lithium can cause hypothyroidism. In a patient whose bipolar disorder is stable and whose lithium level and renal function are therapeutic, hypothyroidism is usually treated while lithium is continued with ongoing thyroid and renal monitoring.

Reference: American Psychiatric Association: Bipolar Disorder Practice Guideline: https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines