A 64-year-old man in ICU for septic shock is evaluated for abnormal thyroid function tests. Patient is febrile, skin is warm and dry, no proptosis, normal size thyroid glands with no nodules. TSH is 0.1 mU/L (normal 0.4-4.0)T3 is 50 ng/dL (normal 80-220), AND T4 is 0.9 ng/dL (normal 0.7-1.8). Which of the following s the most likely diagnosis of abnormal thyroid function?
سؤال مجاني 2 من 10 اليوم · اشترك وكمّل بدون حد
اعرض الإجابة
الإجابة والشرح
ادخل لحسابك عشان نحفظ إجاباتك ونوريك أخطاءك.
الإجابة: A. Euthyroid sick syndrome
A critically ill (septic) patient with low T3, low TSH and normal T4 has euthyroid sick syndrome: cytokines reduce peripheral T4→T3 conversion. He has no goitre, proptosis or nodules. Graves/subacute thyroiditis would raise T3/T4, and Hashimoto would raise TSH.
ليش كل خيار صح أو غلط
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A
ليش صح
In acute illness, raised cytokines reduce T4-to-T3 conversion, giving low T3 (and high rT3) in a euthyroid sick patient; the thyroid gland itself is normal.
✓ 1• Hypothyroidism [Notes].pdf · p. 6 -
B
ليش غلط
Graves is primary hyperthyroidism: low TSH but high T3 and T4. Here T3 is low and T4 normal, so it does not fit.
✓ Endocrine ✳️.pdf · p. 11 -
C
ليش غلط
Hashimoto causes primary hypothyroidism with high TSH and low T3/T4; this patient's TSH is low (0.1).
✓ Endocrine ✳️.pdf · p. 13 -
D
ليش غلط
Subacute thyroiditis gives transient hyperthyroidism from hormone leaking out of an inflamed, tender gland; here T3 is low and the gland is normal in size.
✓ Step Up To Medicine 6th Edition 2024 (Thyroid).pdf · p. 9
- المصدر
- 1• Hypothyroidism [Notes].pdf · p. 6
- المحاضرة
- Thyroid Disorders · Endocrinology · Module B
- ظهر في
- Endo bank