Question

You ask Kate some more questions, and she admits she has had problems with headaches and constipation. She also says that she feels “sluggish” and “in a fog”. You notice that she speaks slowly, and her voice seems rough. On examination, her skin is very dry, she has general puffiness, and examination of her thyroid reveals normal size. Her lab work is as follows:

Kate’s lab values: Reference range: TSH: TSH 25 μU/mL 0.5-4.70 µIU/mL T4, total: 3 μg/dL 4.5-12.5 µg/dL FT4: 0.4 ng/dL 0.8-1.8 ng/dL T3: 80 ng/dL 80 -200 ng/dL Thyroperoxidase antibodies (-) negative

1. Based on Kate’s laboratory values, what diagnosis would you give her? Is Kate’s condition considered autoimmune; why or why not?

2. Explain the relationship between TSH, T4, and T3 values--how do they rise and fall in relationship to one another?

3. Explain the pathophysiologic mechanism that causes Kate’s TSH to be elevated. What glands are involved? Why is Kate’s TSH elevated while her thyroid hormones are not?

Answer 1

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