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Old 06-01-2012
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Thyroid Septic patient with abnormal thyroid function test

A 75-year-old man is admitted to the intensive care unit with sepsis associated with pneumonia, hypoxemic respiratory failure requiring ventilator support, and hypotension. He is treated appropriately with volume resuscitation, vasopressors, and antibiotic therapy and is extubated 5 days later.
On physical examination, blood pressure is 110/75 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Examination of the neck reveals a thyroid gland of normal size and without nodules. There are no tremors in the extremities.
Because results of admission laboratory studies showed mild hyponatremia, additional blood tests are performed to evaluate the hyponatremia.
Cortisol (8 AM) 30 μg/dL (828 nmol/L) (normal range, 5-25 μg/dL [138-690 nmol/L])
Thyroid-stimulating hormone 0.23 μU/mL (0.23 mU/L)
Thyroxine (T4), free 0.9 ng/dL (11.6 pmol/L)
Triiodothyronine (T3), free 0.4 ng/L (0.6 pmol/L)

Which of the following is the most appropriate next management step?
(A) Brain MRI
(B) Levothyroxine administration
(C) Repeat thyroid function tests in 6 weeks
(D) Ultrasonography of the thyroid gland
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Old 06-01-2012
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(C) Repeat thyroid function tests in 6 weeks

it is normal for TSH T3/4 to be low transiently post severe non thyroid illness.

(i dont know if it is treated...
hence answer cud be B)
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Old 06-01-2012
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Quote:
Originally Posted by tyagee View Post
A 75-year-old man is admitted to the intensive care unit with sepsis associated with pneumonia, hypoxemic respiratory failure requiring ventilator support, and hypotension. He is treated appropriately with volume resuscitation, vasopressors, and antibiotic therapy and is extubated 5 days later.
On physical examination, blood pressure is 110/75 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Examination of the neck reveals a thyroid gland of normal size and without nodules. There are no tremors in the extremities.
Because results of admission laboratory studies showed mild hyponatremia, additional blood tests are performed to evaluate the hyponatremia.
Cortisol (8 AM) 30 μg/dL (828 nmol/L) (normal range, 5-25 μg/dL [138-690 nmol/L])
Thyroid-stimulating hormone 0.23 μU/mL (0.23 mU/L)
Thyroxine (T4), free 0.9 ng/dL (11.6 pmol/L)
Triiodothyronine (T3), free 0.4 ng/L (0.6 pmol/L)

Which of the following is the most appropriate next management step?
(A) Brain MRI
(B) Levothyroxine administration
(C) Repeat thyroid function tests in 6 weeks
(D) Ultrasonography of the thyroid gland
euthyroid sick synd
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Old 06-01-2012
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(C) Repeat thyroid function tests in 6 weeks

Quote:
Ill patients may have normal to low TSH depending on the spectrum of illness. Total T4 and T3 levels may be altered by binding protein abnormalities, and medications. Reverse T3 are generally increased signifying inhibition of normal Type 1 enzyme or reduced clearance of reverse T3. Generally the levels of Free T3 will be lowered, followed by the lowering of Free T4 in relation to severity of the disease.Patients might have high corticosteroid level.
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