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NBME 24 Answers

nbme24/Block 1/Question#37 (24.3 difficulty score)
A 25-year-old woman at 16 weeks' gestation ...
Increased hepatic production of T4-binding globulin🔍

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 +6  upvote downvote
submitted by famylife(75),
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easIcr"den lbodo tonitsecacnrno of digninbT-4 uli:ngolb TBG si noe of resalev orenptis atht nptorarst hdtyroi osohenmr in ob,old adn ahs het ehighst yniftaif fro T4 y)irxnh(eto fo hte opgr.u sonerEsgt uiastmlte enorpseisx fo TBG in l,ivre dan teh rmaonl eisr ni rsegoent rgdniu ngpcreayn cisedun ylhugro a gbldonui ni uesmr TBG .rttecontao"nnrcsia

drecIaens" esvlle of TBG eadl ot edrwloe rfee 4T ccteaonotri,nsn ciwhh ustersl ni tlvadeee TSH isteeonrc by teh tytriuipa dan, etns,uycnqelo ehncndea npooiurcdt adn oteciesrn of tdrhyio ormehns.o ehT etn tcffee of tdelevae GTB hseintyss si to croef a ewn rqbluimiieu btnewee efre and boudn ytrdiho hsoenomr and uhst a isiitcnngfa csrneaei ni atolt 4T and 3T velel.s heT ceriasedn emaddn orf htryodi nrmoesoh si eadcerh by taobu 20 wekse fo otteaigsn and isstprse ulitn er."mt


Struma ovarii is a type of teratoma that produces thyroid hormone. However, due to the negative fb, TSH levels would be extremely low.

Similarly, Graves would have low TSH.

Placenta delivers T4 to fetus, not the other way around. Also, fetus starts to make thyroid hormone around 16 weeks and if it were going to the mother, you'd see negative fb on TSH as well.

TSH producing pituitary tumor would have a high TSH.

Prenatal vitamins can affect absorption of treatment for hypothyroidism (due to dications or whatever). They do not contain T4 because that just doesn't make sense lol

+3/- thotcandy(44),

  • total T4 (or T3) = free + TBG-bound
  • pregnancy → TBG increase → TBG-bound T4 increase → free decrease → less negative feedback → more TSH → restore free T4 levels
abhishek021196  Very simple explanation. Thank you +  

 +5  upvote downvote
submitted by gonyyong(81),
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I tkhin hwat trewh em off hwit htsi noiqtseu wsa semu"r T"4 - ntas'w rsue fi htat aetnm atlto 4T ro rumes T4. l,uiLcyk I od'tn tnikh any fo eht tehro enso fti rfo ihtree os I aedsmus ti emtan atolt T4 orf wcihh eht nwaesr eaksm ensse