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Medicine

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Endocrine

Question
4 out of 18
 

The Lab investigation of patient shows T3, T4, & TSH. It cannot be : (AIIMS Nov 2011)



A Primary hypothyroidism
B Pan-hypopituitarism

C Liver disease
D None of the above

Ans. A

Primary hypothyroidism

Basic tests:

1). Measurement of free T4 and T3 levels is more useful than total T4 & total T3 levels as the latter are affected by TBG.

2). Total T4 and T3 are when TBG is and vice versa.

3). But if TBG levels change than free T3 and T4 levels are not affected.

Extra Edge:

1). TBG is in pregnancy, oestrogen therapy (HRT, oral contraceptive pill) and hepatitis.

2). TBG is in nephrotic syndrome and malnutrition (protein loss), drugs (eg androgens, corticosteroids, phenytoin), chronic liver disease and acromegaly.

Assessment of thyroid function Test.

a. T4, and TSH = Primary Hypothyroidism

b. Normal T4, TSH = subclinical hypothyroidism (TSH being the main determinant in deciding)

c. TSH T4 = TSH secreting pituitary tumour or thyroid hormone resistance

d. TSH, T4 or T3 = Hyperthyroidism

e. TSH, Normal T4 & T3 = Subclinical hyperthyroidism

f. TSH, T4 T3 = Sick euthyroidism, Secondary hypothyroid due to hypopituitary.

Extra Edge: TSH is the best test to assess hypothyroid.

Endocrine Flashcard List

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