Q:

What is the typical thyroid profile seen in a patient with thyrotoxicosis?

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A 30-year-old woman presents with complaints of palpitations, tremulousness and weight loss of around 4 kg (despite a good appetite) over the last 2 months. On examination, she is anxious, has a pulse rate of 100/min, warm and moist peripheries, fine tremors of the outstretched hands and a visible goiter. No obvious abnormalities in the eyes. Her last menstrual period was 15 days ago. Her primary care physician orders for laboratory examination which reveals normal hemogram with an erythrocyte sedimentation rate of 25 mm in the first hour. Thyroid stimulating hormone (TSH) <0.001 mIU/L and total T4 28 mg/dL. A diagnosis of thyrotoxicosis is made. She is started on beta-blockers and she is asked to get a technetium uptake scan and review.

What is the typical thyroid profile seen in a patient with thyrotoxicosis?

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The relationship between free T4 and TSH (when the pituitary-thyroid axis is intact) is an inverse log-linear relationship; therefore, small changes in free T4 result in large changes in serum TSH concentrations. Thus, suppressed TSH levels are considerably more sensitive than direct thyroid hormone measurements for assessing thyroid hormone excess states.

A suppressed TSH level with normal or elevated T4 and/or T3 levels are characteristic of thyroid hormone excess (exogenous or endogenous).

• Thyrotoxicosis refers to the clinical syndrome of hypermetabolism due to excessive circulating thyroid hormones.

• Hyperthyroidism is the sustained increase in thyroid hormone biosynthesis.

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