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  #1  
Old 07-18-2013
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Thyroid Thyroid Hormone level alterations

Can someone explain me these scenarios and the exact serum levels:
1) OCP use and serum Free,bound,total and TSH..

2) Pregnancy and serum levels..
Does TSH stimulation by hcg with mild inc free T3,T4 and mild dec TSH considered?

3) Hormone replacement in a pt with hypothyroidism and serum levels..
The need for increased requirement of thyroid hormone is due to p450 induction and inc vol of distribution due to inc bound forms but Whats happening to the free T3,T4 here ?
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  #2  
Old 07-18-2013
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Default Altered ca levels

Also correct me regarding calcium levels if i am wrong..

1) Hypoalbuminemia: dec bound forms but normal free ca = dec total ca
No hypocalcemia symptoms

2) Alkalosis : inc bound forms which dec free ca,total ca remains same..
dec free ca leads to hypocal symptoms..
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Old 07-20-2013
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Hmm no one..!
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Old 07-20-2013
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Quote:
Originally Posted by usmleprep_sr View Post
Can someone explain me these scenarios and the exact serum levels:
1) OCP use and serum Free,bound,total and TSH..

2) Pregnancy and serum levels..
Does TSH stimulation by hcg with mild inc free T3,T4 and mild dec TSH considered?

3) Hormone replacement in a pt with hypothyroidism and serum levels..
The need for increased requirement of thyroid hormone is due to p450 induction and inc vol of distribution due to inc bound forms but Whats happening to the free T3,T4 here ?
1) OCP use and serum Free,bound,total and TSH..
You will find INCREASED TOTAL thyroid hormones with the free component unchanged, the total level increases because estrogen stimulates Thyroid binding globulin production. I dont know the changes regarding TSH, but I would assume they are unchanged or slightly decreased.

2) Pregnancy and serum levels..
Does TSH stimulation by hcg with mild inc free T3,T4 and mild dec TSH considered?

The changes are most the time negligible , hcg may act like TSH because they share the same alpha component, but dont worry about it.

3) Hormone replacement in a pt with hypothyroidism and serum levels..
The need for increased requirement of thyroid hormone is due to p450 induction and inc vol of distribution due to inc bound forms but Whats happening to the free T3,T4 here ?[/QUOTE]

I dont understand your question here, if the woman needs thyroid replacement therapy regardless if she is pregnant or not the free T4 (which is the one that matters) will be low.. so OBVIOUSLY free T3 and T4 will be low if the woman requires thyroid hormone to begin with.

Explain better what you want or where are you getting this from.. because the questions are not clear from the beginning
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  #5  
Old 07-20-2013
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Quote:
Originally Posted by XpaezX View Post
1) OCP use and serum Free,bound,total and TSH..
You will find INCREASED TOTAL thyroid hormones with the free component unchanged, the total level increases because estrogen stimulates Thyroid binding globulin production. I dont know the changes regarding TSH, but I would assume they are unchanged or slightly decreased.

2) Pregnancy and serum levels..
Does TSH stimulation by hcg with mild inc free T3,T4 and mild dec TSH considered?

The changes are most the time negligible , hcg may act like TSH because they share the same alpha component, but dont worry about it.

3) Hormone replacement in a pt with hypothyroidism and serum levels..
The need for increased requirement of thyroid hormone is due to p450 induction and inc vol of distribution due to inc bound forms but Whats happening to the free T3,T4 here ?
I dont understand your question here, if the woman needs thyroid replacement therapy regardless if she is pregnant or not the free T4 (which is the one that matters) will be low.. so OBVIOUSLY free T3 and T4 will be low if the woman requires thyroid hormone to begin with.

Explain better what you want or where are you getting this from.. because the questions are not clear from the beginning[/QUOTE]

Sorry i wasn't clear about the last Q..
A menopausal lady with h/o hypothyroidism and already on thyroxine..what happens to the thyroid hormone levels and its requirement once estrogen replacement is started..?
Acc to UW:There is increased requirement of thyroid hormone which is due to p450 induction and inc vol of distribution due to inc bound forms..So free T4 is normal or low here..?
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Old 07-20-2013
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Quote:
Originally Posted by usmleprep_sr View Post
I dont understand your question here, if the woman needs thyroid replacement therapy regardless if she is pregnant or not the free T4 (which is the one that matters) will be low.. so OBVIOUSLY free T3 and T4 will be low if the woman requires thyroid hormone to begin with.

Explain better what you want or where are you getting this from.. because the questions are not clear from the beginning
Sorry i wasn't clear about the last Q..
A menopausal lady with h/o hypothyroidism and already on thyroxine..what happens to the thyroid hormone levels and its requirement once estrogen replacement is started..?
Acc to UW:There is increased requirement of thyroid hormone which is due to p450 induction and inc vol of distribution due to inc bound forms..So free T4 is normal or low here..?[/QUOTE]

Ohh ok, then it is exactly the same as if the woman was pregnant, that is you will increase the dose because of p450 induction.
I dont know what the free T4 will be, probably a little low because more is bound to protein.

This like a minute detail and I dont think you have to worry that much about this. Just remember to increase the dose in case you have a pregnant woman OR a lady taking OCP's and thats it.
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Old 07-21-2013
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Thank You so much fr all the clarifications..Good Luck..
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