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Clinical chemistry - Essay Example

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Clinical Chemistry Instructor University Thyroid Function 1: Patients suspected for hypothyroidism are requested for number of laboratory work ups to confirm the diagnosis and determine the underlying etiology. The first step in evaluating most thyroid diseases is to measure the TSH levels…
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Clinical chemistry

Download file to see previous pages... As autoimmune hypothyroidism is most common primary cause, detecting presence of thyroid peroxidase antibodies (TPOAb) will confirm the diagnosis. If these antibodies are absent other causes of hypothyroidism must be clinically evaluated. (Harrison 2005, pp.2108-2109) Even if the unbound T4 levels are normal but TSH levels are elevated, it reflects the presence of mild hypothyroidism and thyroid peroxidase antibodies test should be performed. In cases where patient clinically presents with hypothyroidism but TSH levels are normal a pituitary or secondary disease can be expected. For those patients testing for unbound T4 levels becomes necessary and if low other causes of hypothyroidism such as drug effects, euthyroid syndrome can be suspected. A further anterior pituitary evaluation work up is required for such patients. (Harrison 2005, pp.2108-2109) 2: Thyroid stimulating hormone is important marker for thyroid activity, mainly because of sensitive negative feedback mechanism. Any increase in thyroid hormone concentration will promptly decrease its production. Similarly, any abnormal decrease in the active form of thyroid hormones will raise its level in the blood. So a single measurement of TSH can give a lot of information about the activity of the thyroid gland. This is the reason it is used as a screening test for most of the thyroid abnormalities. If normal, a simple TSH measurement can rule out most primary diseases of the thyroid gland with only few exceptions. In very cases elevated TSH may not at all be associated with thyroid gland and, therefore, may be misleading. For example, TSH may be elevated in a rare TSH secreting pituitary tumor as well. So after the initial screening test, further tests are required for diagnosis. (Harrison 2005, p.2108) Although, TSH can point toward some abnormality of the thyroid gland, it cannot determine the exact underlying pathology. Therefore, further unbound or free T3 and T4 levels are measured to confirm the diagnosis of either hyper or hypothyroidism. So hormone levels in conjunction with TSH levels will provide the complete information for the diagnosis of most thyroid abnormalities. (Harrison 2005, p.2108) 3: The lab results are consistent with hypothyroidism. Patient has elevated TSH levels with decreased levels of unbound T4. Moreover, the clinical findings of weight gain and fatigue are also indicating decreased thyroid hormones. As discussed earlier, autoimmune destruction of thyroid tissue is the most common cause for hypothyroidism. The disease may be associated with a goiter as in Hashimoto’s thyroiditis or at more chronic stage without a goiter as in the case of atrophic thyroiditis. The most significant finding is the lymphocytic infiltration in the thyroid tissue accompanied by B cells. The autoimmune destruction is caused primarily by cytotoxic T cells resulting in decreased T4 production and prompt rise of TSH levels. (Harrison 2005, p.2110) The treatment for hypothyroid patients varies depending on the severity of the disease. For patients with complete loss of hypothyroid function as in the case of clinical hypothyroidism, levothyroxine daily replacement dose of 1.6µg/kg body weight is administered. Adult patients, with age less than 60 are started at lower doses with adjustments done later on depending on the clinical and lab findings. Subclinical hypothyroidism is the initial stage of the disease where rise in TSH level ...Download file to see next pagesRead More
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