08-02-2009, 07:27 PM
57 year old man comes to the physician for a routine health maintenance examination. He takes an ACE inhibitor for hypertension and has been advised to lose weight. He works as a pharmacist. His temperature is 99 deg F, pulse is 92, respirations 14, and blood pressure is 152/94. Exam shows no abnormalities. Serum thyroid studies show a TSH hormone concentration is 0.2, thyroxine (T4) of 18, and triiodothyronine (T3) concentration of 220. A radioactive thyroid scan shows decreased uptake and a small gland. Which of the following is the most likely cause of this patient's findings?
A) Acute suppurative thyroiditis
B) Chronic lymphocytic thyroiditis (Hashimoto disease)
C) Drug-induced hypothyroidism
D) Euthyroid sick syndrome
E) Exogenous administration
F) Graves disease
G) Multiple endocrine neoplasia, type 2
H) Subacute thyroiditis
I) Thyroid cancer
Is it D? But in euthyroid shouldn't TSH be around normal and hormones be a bit low? In this case TSH is low and the hormones are normal. Any explanation?
A) Acute suppurative thyroiditis
B) Chronic lymphocytic thyroiditis (Hashimoto disease)
C) Drug-induced hypothyroidism
D) Euthyroid sick syndrome
E) Exogenous administration
F) Graves disease
G) Multiple endocrine neoplasia, type 2
H) Subacute thyroiditis
I) Thyroid cancer
Is it D? But in euthyroid shouldn't TSH be around normal and hormones be a bit low? In this case TSH is low and the hormones are normal. Any explanation?