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Free T4 is high with hyperthyroidism and low with hypothyroidism. It’s important to note that even a high TSH with normal T4 is enough to identify hypothyroidism. A rare pattern and one indicative of a hereditary thyroid resistance condition is high FT4. High FT4 can also be caused by taking heparin or by an acute illness that causes binding protein levels to suddenly fall. If an illness other than thyroid disease becomes severe or chronic, it may decrease FT4. Functional Range: 1.0-1.5 ng/ dL Typical Laboratory Range: 0.7-1.53 ng/dL

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S.P. is a 68-year-old retired painter who is experiencing right leg calf pain. The pain began approximately 2 years ago but has become significantly worse in the past 4 months. The pain is precipitated by exercise and is relieved with rest. Two years ago, S.P. could walk two city blocks before having to stop because of leg pain. Today, he can barely walk across the yard. S.P. has smoked two to three packs of cigarettes per day (PPD) for the past 45 years. He has a history of coronary artery disease (CAD), hypertension (HTN), peripheral vascular disease (PVD), and osteoarthritis. Surgical history includes quadruple coronary artery bypass graft (CABG × 4) 3 years ago. He has had no further symptoms of cardiopulmonary disease since that time, even though he has not been compliant with the exercise regimen his cardiologist prescribed, he continues to eat anything he wants, and continues to smoke two to three PPD. Other surgical history includes open reduction internal fixation of the right femoral fracture 20 years ago. S.P. is in the clinic today for a routine semiannual follow-up appointment with his primary care provider. As you take his vital signs, he tells you that, besides the calf pain, he is experiencing right hip pain that gets worse with exercise, the pain doesn't go away promptly with rest, some days are worse than others, and his condition is not affected by a resting position. � Chart View General Assessment Weight 261 lb Height 5 ft, 10 in. Blood pressure 163/91 mm Hg Pulse 82 beats/min Respiratory rate 16 breaths/min Temperature 98.4° F (36.9° C) Laboratory Testing (Fasting) Cholesterol 239 mg/dL Triglycerides 150 mg/dL HDL 28 mg/dL LDL 181 mg/dL Current Medications Lisinopril (Zestril) 20 mg/day Metoprolol (Lopressor) 25 mg twice a day Aspirin 325 mg/day Simvastatin (Zocor) 20 mg/day Case Study 4 Name Class/Group Date ____________________ Group Members INSTRUCTIONS All questions apply to this case study. Your responses should be brief and to the point. When asked to provide several