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 +26  upvote downvote
submitted by โˆ—m-ice(370)
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They explicitly state that the patient has been taking excess of his levothyroxine medication. Levothyroxine is the exogenous form of T4. Therefore, free T4 must be elevated. T4 is converted to T3 at most peripheral tissues, so T3 will also be elevated. Because the body has more thyroid hormone than needed, less TSH will be made, and the thyroid will be less active, taking up LESS iodine.

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procrastinator  I forgot that T4 is converted to T3 :( +5



 +4  upvote downvote
submitted by โˆ—greentea733(23)
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Why wouldn't the body down-regulate the conversion of FT4 into FT3? Is that conversion just constitutively activated? Since FT3 is more potent than T4, it would make sense for the body to turn that conversion down...that was my reasoning...obviously not correct, but idk why that wouldn't be the case. Anyone have insight?

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maria_danieli  i thought the same... i remember that T3 conversion is somehow regulated but evidently not in this case +1
sars  Peripheral conversion of free T4 to T3 is done by 5-deiodinase. From what I know, only way to decrease this conversion is via b-blockers, glucocorticoids, propylthiouracil, and potassium iodide (lugols). I believe this was mentioned in the sketchy pharm vid as well. +2
sars  Peripheral conversion of free T4 to T3 is done by 5-deiodinase. From what I know, only way to decrease this conversion is via b-blockers, glucocorticoids, propylthiouracil, and potassium iodide (lugols). I believe this was mentioned in the sketchy pharm vid as well. +1
sars  4th blocking agent isn't lugols, its iodinated radiocontrast dye! Sorry for that mistake. +1
cassdawg  "T3 is derived from peripheral conversion of T4... normal plasma T3 levels are obtained in athyreotic patients treated with sufficient T4 to achieve high-normal plasma (F)T4 levels. Administration of T4 to hypothyroid rats to achieve normal plasma T4 levels results in subnormal plasma T3 levels not only because of the lack of T3 secretion but also because of a decreased T3 production by D1 in peripheral tissues, since this enzyme is under positive control of T3 itself". (https://www.ncbi.nlm.nih.gov/books/NBK285545/) i.e. because he is taking SUPRATHERAPEUTIC T4 his T3 is NORMAL. If he was taking NORMAL T4 then he would have DECREASED T3. Pretty sure the normal T4/decreased T3 thing is in another NBME test or UWorld somewhere. +1
cassdawg  ^Sorry to add, her is suprasupratherapeutic so his T3 is elevated. Essentially in a normal hypothyroid patient they are given supratherapeutic T4 to get normal T3 since T3 is the hormone with the action. Apologies if anything is confusing. +2



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submitted by โˆ—sweetmed(157)
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Taking excess Levothyroxine will cause, Incr fT4, Incr fT3, decr TSH, decr Thyroidal iodine uptake. Excess liothyronine intake will cause incr T3, Decr T4, decr rT3, Decr TSH, because T4 gets converted to T3 and rT3 in periphery.

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 +0  upvote downvote
submitted by โˆ—kevintkim4(4)
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A bit confused here because I thought T4 is converted to T3 INSIDE peripheral tissue. Why would serum T3 levels rise then?

According to this article, patients with hypothyroidism taking too much levothyroxine ended up having NORMAL serum T3 levels: https://pubmed.ncbi.nlm.nih.gov/26738396/#:~:text=In%20levothyroxine%20(T4)%2Dinduced,in%20over%2Dtreated%20hypothyroid%20patients.

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