On these “Gold Standard Internal Medicine Facts” pages you will find Free:
- USMLE Audio Review files from our “Gold Standard USMLE Reviews”
- Transcriptions of those files
- And videos (as they become available)
The idea is that you can review for the USMLE online by:
- Listening to the Audio
- Following along with the transcription
- Or by watching the video (if available)
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Let’s start our USMLE Review with Hypothyroidism and Hyperthyroidism from the Gold Standard USMLE Foundations of Medicine Audio Review program.
Play USMLE Audio MP3 10 10 Findings – Autoimmune Diseases Below
Begin 10 10 Findings – Autoimmune Diseases Transcription
Moving now to diagnosis of the adult hypothyroid patient.
The combination either of which two serum levels along with an elevated TSH is diagnostic for primary hypothyroidism?
- The combination of a low serum FT4 or FT4i and an elevated TSH level is diagnostic for primary hypothyroidism.
What does FTi stand for in this context?
- Free Thyroxine index.
Are serum T3 levels significant in the diagnosis of adult hypothyroidism?
- No, T3 levels are variable and may remain within the normal range.
Which underlying thyroid disease is implicated by a positive test for thyroid auto-antibodies?
- A positive test for thyroid auto-antibodies suggest underlying Hashimoto’s thyroiditis.
Pituitary myxedema patients show a low FT4 or FT4i but serum TSH will not be elevated. It may then be necessary to differentiate pituitary from hypothalamic disease.
Which test is most useful in achieving this differentiation?
- The TRH (thyrotropin-releasing hormone) test best distinguishes pituitary from hypothalamic disease.
Does an absence of TSH response to TRH indicate pituitary or hypothalamic deficiency?
- Pituitary deficiency.
And what is indicated by a partial or normal TSH response to TRH?
- A partial or normal response indicates pituitary function is intact but there is a defect in hypothalamic secretion of TRH.
Student doctor please pause the tape and summarize serum testing of FT4 or FT4i, T3, TSH, thyroid auto-antibodies, and TRH in the diagnosis of adult hypothyroidism.
- The combination of a low serum free Thyroxine or free Thyroxine index result and an elevated TSH level is diagnostic of primary hypothyroidism. T3 levels are variable and may remain in a normal range. A positive test for thyroid auto-antibodies suggests underlying Hashimoto’s thyroiditis. Pituitary myxedema patients reveal low free Thyroxine but serum TSH is not be elevated. It may necessary to differentiate pituitary from hypothalamic disease using the TRH (thyrotropin-releasing hormone) test. Absence of TSH response to TRH indicates pituitary deficiency, while a partial or normal response suggest intact pituitary function but with defective hypothalamic secretion of TSH.
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