WBR0213
| Author | PageAuthor::Vendhan Ramanujam |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Endocrine, SubCategory::Endocrine |
| Prompt | [[Prompt::A 56 year old diabetic male is admitted to the coronary care unit with acute myocardial infarction complicated by cardiogenic shock. His hospital course was complicated by acute renal failure. His thyroid study came out as abnormal. He does not have any previous history of thyroid disease. Physical examination of the thyroid gland is found to be normal. Lab result of the thyroid study is as follows: Serum T3: 1.1 nmol/L (Normal 1.8 to 2.9 nmol/L) |
| Answer A | AnswerA::Primary hypothyroidism |
| Answer A Explanation | [[AnswerAExp::Incorrect-Decreased total and free T4 with increased TSH level is seen in primary hypothyroidism.]] |
| Answer B | AnswerB::Central hypothyroidism |
| Answer B Explanation | AnswerBExp::'''Incorrect'''-Low T4 with normal TSH level can be seen in central hypothyroidism. |
| Answer C | AnswerC::Subclinical hypothyroidism |
| Answer C Explanation | AnswerCExp::'''Incorrect'''-Normal T3 and T4 with increased TSH level is seen in subclinical hypothyroidism. |
| Answer D | AnswerD::Sick euthyroid syndrome |
| Answer D Explanation | [[AnswerDExp::Correct-Any patient with acute and severe illness may have an abnormal thyroid function test. This is sick euthyroid syndrome (low T3 syndrome), which is due to the caloric deprivation and increased cytokine levels during the period of illness. The abnormality pattern is usually a low total or free T3 level with normal T4 and TSH levels, due to decrease in the peripheral conversion of T4 to T3. Longer the duration of illness, T3 fall might be followed by fall in T4 and TSH levels. On recovery from illness there might be a transient increase in TSH levels. For this reason, a thyroid test is usually not performed in severely ill patients unless there is a strong indication, since these abnormalities can be misleading.]] |
| Answer E | AnswerE::Reidels thyroiditis |
| Answer E Explanation | AnswerEExp::'''Incorrect'''-Reidels thyroiditis presents as primary hypothyroidism. |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::Any patient with acute and severe illness may have an abnormal thyroid function test. This is sick-euthyroid syndrome (low T3 syndrome), which is due to the caloric deprivation and increased cytokine levels during the period of illness. The abnormality pattern is usually a low total or free T3 level with normal T4 and TSH levels, due to decrease in the peripheral conversion of T4 to T3. Longer the duration of illness, T3 fall might be followed by fall in T4 and TSH levels. On recovery from illness there might be a transient increase in TSH levels. For this reason, a thyroid test is usually not performed in severely ill patients unless there is a strong indication, since these abnormalities can be misleading.
Educational objective:
Any acute and severely ill patient might have an abnormal thyroid function test. This is called sick euthyroid syndrome (low T3 syndrome) with a low T3 and normal T4, TSH levels, the most common abnormal pattern. |
| Approved | Approved::Yes |
| Keyword | |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |