please answer - ihs2009

[ArchivalUser]

A 50 y/o HIV +ve man with a CD4 count of 200 prrsents with complaints of fatigue, weightloss and dry cough. Cough has been for past 2 days and has high grade fever. No chest pain but he is visibly short of breath. His ABGs revealed hypoxemic respiratory failure with a po2 of 45. He is started on Bactrim IV and steroids.
Laboratory Studies reveal
Free thyroxine 0.9 ng/dL
Triiodothyronine 22 ng/dL
Thyroid-stimulating hormone 0.3 μU/mL
Which of the following statements about this patient™s condition is true?
( A ) Perform a radioactive iodine uptake test
( B ) Using T3 treatment will improve his condition and prognosis.
( C ) The lab abnormalities are due to decreased peripheral conversion of thyroxine to triiodothyronine
( D ) Serum thyroid binding globulin is increased
( E ) Pituitary MRI should be obtained

[ArchivalUser]

c............

[ArchivalUser]

ccccccccccccccc

[ArchivalUser]

looks like ESS and the answer should be C!

[ArchivalUser]

Thanks for the input, I don't have the correct answer to confirm, but I alo think it is c, Thanks again

[ArchivalUser]

all labs are in normal range except low TSH (kinda borderline low), suggesting subclinical hyperthyroidism. Maybe there's an increase in total T4 but masked by an increase in TBG. TBG is known to rise with falling CD4 count.

[ArchivalUser]

Sorry, the T3 is indeed low @ 22, so you're dealing with euthyroid sick sdr or nonthyroidal sickness sdr where you expect to see low T3 and low to normal T4 due to inhibition of 5'-deiodinase. Answer C.

[ArchivalUser]

answer is C
This is euthyroid sick syndrome. this same question is in archer review, it says answer is C