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NBME 24 Answers

nbme24/Block 1/Question#37

A 25-year-old woman at 16 weeks' gestation comes to ...

Increased hepatic production of T4-binding globulin

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 +4  upvote downvote
submitted by famylife(32),

"Increased blood concentrations of T4-binding globulin: TBG is one of several proteins that transport thyroid hormones in blood, and has the highest affinity for T4 (thyroxine) of the group. Estrogens stimulate expression of TBG in liver, and the normal rise in estrogen during pregnancy induces roughly a doubling in serum TBG concentratrations."

"Increased levels of TBG lead to lowered free T4 concentrations, which results in elevated TSH secretion by the pituitary and, consequently, enhanced production and secretion of thyroid hormones. The net effect of elevated TBG synthesis is to force a new equilibrium between free and bound thyroid hormones and thus a significant increase in total T4 and T3 levels. The increased demand for thyroid hormones is reached by about 20 weeks of gestation and persists until term."

 +1  upvote downvote
submitted by gonyyong(19),

I think what threw me off with this question was "serum T4" - wasn't sure if that meant total T4 or serum T4. Luckily, I don't think any of the other ones fit for either so I assumed it meant total T4 for which the answer makes sense