Endocrinology: non-thyroidal illness: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: non-thyroidal illness

Sample item

A 62-year-old man in the intensive care unit with septic shock has no prior thyroid disease. Thyroid tests show TSH 0.2 mIU/L (reference 0.4 to 4), free T4 at the lower limit of normal, low total T3 and raised reverse T3. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. No thyroid hormone replacement, and repeat thyroid function after recovery

Non-thyroidal illness (sick euthyroid syndrome) results from cytokine-mediated inhibition of T4 to T3 conversion, with low T3, raised reverse T3 and a low or normal TSH, and TSH may later rebound above normal. Thyroid hormone replacement has not been shown to benefit and may harm, so no treatment is given and tests are repeated four to six weeks after recovery.

Option by option

  • A. Start an intravenous liothyronine infusion

    T3 infusion has not improved outcomes in this condition and can provoke arrhythmias.

  • B. No thyroid hormone replacement, and repeat thyroid function after recovery (correct)

    The pattern is adaptive and resolves with the illness, so replacement is not indicated.

  • C. Start levothyroxine 100 micrograms daily

    Levothyroxine is not helpful in non-thyroidal illness and the patient is not hypothyroid.

  • D. Start carbimazole for thyrotoxicosis

    Thyroid hormones are not raised, so antithyroid therapy is not appropriate.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, No thyroid hormone replacement, and repeat thyroid function after recovery. Non-thyroidal illness (sick euthyroid syndrome) results from cytokine-mediated inhibition of T4 to T3 conversion, with low T3, raised reverse T3 and a low or normal TSH, and TSH may later rebound above normal.

Why is "Start an intravenous liothyronine infusion" not the answer?

T3 infusion has not improved outcomes in this condition and can provoke arrhythmias.

Why is "Start levothyroxine 100 micrograms daily" not the answer?

Levothyroxine is not helpful in non-thyroidal illness and the patient is not hypothyroid.

Why is "Start carbimazole for thyrotoxicosis" not the answer?

Thyroid hormones are not raised, so antithyroid therapy is not appropriate.

What concept does this question test?

It tests Endocrinology: non-thyroidal illness in General Medicine. Thyroid hormone replacement has not been shown to benefit and may harm, so no treatment is given and tests are repeated four to six weeks after recovery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: non-thyroidal illness?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.