44 y/o woman..another good one - doc_ted

[ArchivalUser]

No i am not, look TSH is normal.

[ArchivalUser]

yes tell the retard hotdogobhaga... the idiot

[ArchivalUser]

can u explain a little more aiisman

[ArchivalUser]

If the T4 level is low and TSH is not elevated, the pituitary gland is more likely to be the cause for the hypothyroidism. Of course, this would drastically effect the treatment since the pituitary gland also regulates the body's other glands (adrenals, ovaries, and testicles) as well as controlling growth in children and normal kidney function. Pituitary gland failure means that the other glands may also be failing and other treatment than just thyroid may be necessary. The most common cause for the pituitary gland failure is a tumor of the pituitary and this might also require surgery to remove.

But i would still treat the patient first with Levothyroxine.
There may be a associated central addisons which would have to be taken care of..but it is not one of the options.
http://www.endocrineweb.com/tests.html

[ArchivalUser]

D pitutary adenoma

[ArchivalUser]

D pitutary adenoma

[ArchivalUser]

srayani got it rite...
who knows srayani and doc_ted are same person

(D) MRI of the brain

Explanation:

In a patient with clinical manifestations of hypothyroidism, the response of a normal pituitary to a failing gland is to secrete thyroid-stimulating hormone (TSH). The "normal" TSH in the patient is actually abnormal because it is an inappropriate response to low levels of thyroid hormone in the blood. The level of TSH should be elevated if the free T4 is truly low. In addition, patients with pituitary disease produce a defective TSH, which has reduced biological activity. Another reason why the MRI is the correct answer is because it may identify a pituitary lesion responsible for the flaccid response of the pituitary to low levels of circulating thyroid hormone. The adrenal function needs to be tested prior to therapy with thyroxine because treatment may lead to a crisis of acute adrenal insufficiency. Thyroid hormone will lead to an increased metabolic state, which can consume the remaining amounts of cortisol and precipitate acute adrenal insufficiency

[ArchivalUser]

if T4 is low, then the TSH should be elevated. i would treat. give levothyroxine (A). must be primary pituatiary problem.

[ArchivalUser]

oh sorry. i did not see the explanation. my deepest apologie