Question

Review the table / figure below to answer the questions. These data were collected from people that had a condition called "subclinical hypothyroidism" - in which the thyroid gland makes adequate T3/T4, but there is elevated TSH. There are strong correlations between chronically elevated TSH and cardiac problems. In this paper, the authors wanted to know whether treatment with T4 would lower TSH levels and therefore alleviate cardiac symptoms. Table 4. Changes in Thyroid Function in Patients with Subclinical Hypothyroidism After Placebo or L-Thyroxine Therapy Months of Therapy Thyrotrophin Placebo Thyroxine He/dL 6.0 +0.3 6.2 +04 6.1 +0.4 Triiodothyronine ng/dL 135 + 6 133 + 10 137 13 139 +7 158 +6 154 10 U/ml 11.1 3.2 15.5 3.6 14.7 3.3 -Thyroxine 6.7 + 0.4 95% 0.5 8.8 +0.6+ 10.8 2.2 2.3 +0.45 2.6 +0.5; • Values are meant SE P<0.001, compared to both place and admission was IP <0.01, compared to both placebo and initial admission values BAZ Figure caption: (Top) circulating blood levels of thyroxin (T4), Triiodothyronine (T3) and Thyrotropin (TSH) after different lengths of treatment with placebo or L-thyroxin (T4). (Side, A) Fancy measures of cardiac function, where higher numbers are 'bad' and lower numbers are 'good. Each subject is recorded before (0 months) and after (12 months) L-thyroxine (T4) treatment. (Side, B) each dot represents a score for the total number of symptoms reported by a single person, in either the placebo or treatment group. PLACEBO L-THYROXINE Positive values represent an improvement in symptoms after the study, negative values represent symptoms got worse, and a score of zero represents that patients had no change in symptoms. SYMPTOM SCORE Questions: 1) did the placebo treatment have any impact on T3, T4 or TSH levels? How do you know? 2) did T4 treatment have any impact on T3, T4 or TSH levels? How do you know? 3) Did treatment with T4 have any impact on cardiac function? How do you know? 4) Did treatment with T4 have any impact on the symptoms that patients experienced before/ after the trial? How do you know? 5) Did T4 therapy effectively treat the subclinical hypothyroidism? How do you know?

Answer 1

Answer 1: placebo treatment has shown no effect on T4 (thyroxin) and T3 (triiodothyronine), however at 6 and 12 month of placebo treatment THS (thyrotrophin) level has slightly increased in blood Answer 2: from table 4 it is dea, Upon T4 (L-thyroxine)treatment level of T4 (6.7 ug/dL to 9.5 ug/dL and 8.8 ug/dL in 6 and 12 month respectively ) and T3 ( 139 ng/dL to 158 ng/dL and 154 ng/dL in 6 and 12 month respectively in blood has increase however, drastic decrease had found in THS which is decreased 10 U/mL to 2.3 U/mL in six month and 2.6 U/mL in 12 month observed Answer3: Cardiac effect on subject were studied and represented by figure Side A. this indicates After T4 treatment number decreases (means good) which is indicative of improvement of cardiac function (comparison of treatment from 0 month to 12 month). Answer 4: comparing the number of symptoms of a patient from placebo treated and T4 treated individuals in Figure Side B. in placebo treated individual the Number of symptoms in Positive coordinate (Improved condition) is 3, symptoms not changed are 8 and number of symptoms in Negative coordinate symptom get worsen) are 6. In T4 treated Number of symptoms in Positive coordinate (Improved condition) is 8. symptoms not changed are5 and number of symptoms in Negative coordinate (symptom get worsen) are 4. Thus, Comparison of number of symptoms of T4 treated to the placebo treated individual, showing improved in symptom. Answer 5: In hypothyroidism Level of T4 and 13 decreased and level of TSH increased. In this study, after treatment of T4, level of T3 and T4 found to be increased and THS found to be decreased moreover, Number of symptoms get improved after T4 treatment increased and cardiac function is also found in good. All studied parameters under T4 treatment are the indicative of the improvement in patients affected with hypothyroidism