Eating and sleep disorders: thyroid function in anorexia nervosa: practice question

A Psychiatry 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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Psychiatry · Eating and sleep disorders: thyroid function in anorexia nervosa

Sample item

A severely underweight woman with anorexia nervosa complains of cold intolerance and constipation. Her thyroid function tests are being interpreted. Which pattern is typical of the starved state?

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

The answer and the reasoning

B. Low T3 with normal or low TSH

Starvation reduces peripheral conversion of T4 to T3, giving low T3 and raised reverse T3 with TSH normal or low. This adaptive change reverses with refeeding and does not need thyroxine. Primary hypothyroidism would show a raised TSH.

Option by option

  • A. Raised T4 with raised TSH

    Raised T4 with raised TSH suggests a TSH-secreting adenoma or assay interference.

  • B. Low T3 with normal or low TSH (correct)

    Correct. Reduced T4 to T3 conversion gives low T3 with a non-raised TSH, an adaptive change.

  • C. Raised T3 with suppressed TSH

    Raised T3 with suppressed TSH is thyrotoxicosis, the opposite of the starved state.

  • D. Low T4 with markedly raised TSH

    Low T4 with a markedly raised TSH is primary hypothyroidism, which is not the usual starvation pattern.

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 Psychiatry question

What is the answer to this Psychiatry question?

The best answer is B, Low T3 with normal or low TSH. Starvation reduces peripheral conversion of T4 to T3, giving low T3 and raised reverse T3 with TSH normal or low.

Why is "Raised T4 with raised TSH" not the answer?

Raised T4 with raised TSH suggests a TSH-secreting adenoma or assay interference.

Why is "Raised T3 with suppressed TSH" not the answer?

Raised T3 with suppressed TSH is thyrotoxicosis, the opposite of the starved state.

Why is "Low T4 with markedly raised TSH" not the answer?

Low T4 with a markedly raised TSH is primary hypothyroidism, which is not the usual starvation pattern.

What concept does this question test?

It tests Eating and sleep disorders: thyroid function in anorexia nervosa in Psychiatry. This adaptive change reverses with refeeding and does not need thyroxine. Primary hypothyroidism would show a raised TSH.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Eating and sleep disorders: thyroid function in anorexia nervosa?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry 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.