5. Ms. M. is a 59-year-old postmenopausal woman. The serum T4 is 8 microg/dl (n.

Question

5. Ms. M. is a 59-year-old postmenopausal woman. The serum T4 is 8 microg/dl (n. 6 – 12); TSH is 4 microg/dl (n. 2 – 10). Body weight – 190 pounds, and she complains of depression. Her physician prescribes a low dosage of T4 to “pep her up”. What changes would you expect to see 4 weeks after the initiation of treatment?

a. the size of thyroid will be reduced

b. serum TSH will decrease

c. serum T4 will decrease

d. the basal metabolism rate will be elevated.

6. Biologic actions of thyroid hormones include all of the following except:

a. stimulate protein synthesis and proteolysis

b. increase Na-K- ATP-ase activity

c. increase oxidative phosphorylation

d. stimulate growth and vascularity of the thyroid gland. e. stimulate glycogenesis

7. Which pair of symptoms and causes is most appropriate for hypothyroidism?

a. the skin is warm and moist because of peripheral vasodilation

b. diarrhea occurs because of increased GI secretion and motility

c. puberty is delayed or absent because TSH crossreacts LH and FSH receptors

d. myxedema occurs because mucopolysaccarides accumulate in the extracellular spaces.

e. there is a tendency to gain weight because appetite increases.

8. If you withdraw insulin from insulin-dependent diabetic patient, you would expect to see all of the following except:

a. a decrease in urinary bicarbonate levels

b. an increase in renal ammonium production

c. an increase release of alanine and glutamate from skeletal muscle

d. a decrease in BUN (blood urea nitrogen)

e. a decrease in PaCO2

9. Correct cause-and-effect relationships following insulin withdrawal in a person with diabetes mellitus include:

a. the ratio of K+ concentration inside the cell to K+ concentration outside the cell decreases in untreated diabetes for multiple reasons, including intracellular H+ buffering, which results in a shift of K+ to the extracellular compartment.

b. ketonemia does not increase urine flow because it is entirely reabsorbed in the renal tubule

c. urinary phosphate decreases because renal excretion of H+ results in increased phosphate reabsorption.

d. serum sodium rises because of fluid shift from the extracellular compartment to intracellular compartment.

e. glomerular filtration rate increases as a result of increased serum glucose concentration.

Explanation / Answer

5. Answer is d. Thyroxine administration will work towards increasing the basal metabolic rate. Effevt on TSH will start to show up only after 6weeks (ideally) to 4 months (in certain cases). The primary functions of T4 includes increasing BMR, regulating bone growth, protein synthesis and neural maturation.

6. Answer is d. Thyroid hormones activate the uncoupling of oxidative phosphorylation through mechanisms that uses inner membrane proteins and lipids.T3 in particular is known to enhance the activity of Na-K-ATPase by synthesising subunits of this enzyme. There are reports suggesting T3 administration for increase in glycogen content of the fetal liver and development of cardiac glycogen content. Thyroid vascularity and blood flow are not dependent on thyroid hormone levels and has been proved through an in vivo study using flow doppler sonography.

7.a. skin is warm, moist, soft, velvety, smooth. Warmth is due to increased cutaneous blood flow and peripheral vasodilation and moisture due to underlying metabolic state.

Patients with hypothyroidism have reduced appetite. Myxedema occurs after total thyroidectomy. TSH may bind to FSH receptors mostly to give FSH or LH like activities, and often causes leutinized ovarian cysts. Hyperthyroidism leads to activation of sympathetic hyperstimulation in gut causing increased motility and diarrhoea.

8.a. withdrawal of insulin results in lot of changes like increase in plasma glucose, branched chain amino acids, non esterified fatty acids, even urinary nitrogen. But bicarbonate does not change.

PaCO2 will be decreased but not as much, just marginally.

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