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Old 10-11-2012
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Arrow Gyrus Daily Questions; Internal Medicine #53

A 44-year-old male is involved in a motor vehicle col-lision. He sustains multiple injuries to the face, chest, anpelvis. He is unresponsive in the field and is intubated for airway protection. An intravenous line is placed. The pa-tient is admitted to the intensive care unit (ICU) with multiple orthopedic injuries. He is stabilized medically and on hospital day 2 undergoes successful open reduc-tion and internal fixation of the right femur and right hu-merus. After his return to the ICU, you review his laboratory values. TSH is 0.3 mU/L, and the total T 4 level is normal. T 3 is 0.6 g/dL. What is the most appropriate next management step?
A. Initiation of levothyroxine
B. A radioiodine uptake scan
C. A thyroid ultrasound
D. Observation
E. Initiation of prednisone
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Old 10-11-2012
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D
he has sick euthyroid syndrome secondary to the shock he suffered.

According to medscape there isnt a consensus on how to proceed, you can either give thyroid hormone or chill.

the recomendation however is to not give anything and just follow-up so i pick D
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so I was reading this one thoroughly concentrated and my right hand was aimlessly searching for the "lab values" button in the firefox browser...
******* me....
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yes D........
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Quote:
Originally Posted by DocSikorski View Post
so I was reading this one thoroughly concentrated and my right hand was aimlessly searching for the "lab values" button in the firefox browser...
******* me....

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answer is D.

Sick-euthyroid syndrome can occur in the setting of any acute, severe illness. Abnormalities in the levels of circulating TSH and thyroid hormone are thought to result from the release of cytokines in response to severe stress. Multiple abnormalities may occur. The most common hormone pattern is a decrease in total and unbound T 3 levels as peripheral conversion of T 4 to T 3 is im-paired. Teleologically, the fall in T 3 , the most active thyroid hormone, is thought to limit catabolism in starved or ill patients. TSH levels may vary dramatically, from 0.1 to >20 mU/L, depending on when they are measured during the course of illness.
Very sick patients may have a decrease in T 4 levels. This patient undoubtedly has ab-normal thyroid function tests as a result of his injuries from the motor vehicle acci-dent. There is no indication for obtaining further imaging in this case. Steroids have no role. The most appropriate management consists of simple observation. Over the course of weeks to months, as the patient recovers, thyroid function will return to normal.
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Endocrinology-, Internal-Medicine-, Step-1-Questions

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