Question

A 67-year-old woman is referred for treatment of hyperlipidemia. Her cholesterol and triglycerides are high, despite treatment with lipid-lowering medication. She is noted to have hair loss and hoarseness to her voice. She also complains of cold intolerance and fatigue. The physician orders a BMP, lipid panel, and thyroid testing cascade. Results are as follows:

Analyte 2/19/2018 09:50 . Reference Range

Na 141 . 135-145 mEq/L

K 4.1 . 3.5-5.0 mEq/L

Cl 101 . 95-105 mEq/L

CO2 25 . 22-28 mEq/L

Glucose 103 . 70-100 mg/dL

BUN 8 . 7-20 mg/dL

Creat 0.4 . 0.5-1.1 mg/dL

BUN/Creat Ratio 20 . 10-20

Total Cholesterol 250 . 150-200 mg/dL

LDL 147 . <100 mg/dL

HDL 41 . 40-80 mg/dL

Triglycerides 310 . <150 mg/dL

TSH 43 . 0.4-4.5 mIU/L

fT4 0.4 . 0.8-2.4 ng/dL

tT3 Not Indicated . 80-180 ng/dL

(1) Highlight the abnormal results in the above table. (1 pt)

(2) Based upon the above clinical and laboratory data, does this patient have hypothyroidism or hyperthyroidism? Is this a primary, secondary, or tertiary thyroid disorder? (3 pts)

(3) The physician suspects an autoimmune etiology. Name the most likely condition and a lab test the can help confirm this potential diagnosis. (2 pts)

(4) Explain why this patient has abnormal glucose, lipid panel, and creatinine results? (4 pts)

Answer 1

1. The abnormal results in the above table are:

• High glucose level 103 and  is normal range 100 mg/dl
• Creatinine ratio 20
• Total cholesterol 250 mg /dl
• LDL 147
• Triglycerides 310 mg /dl
• TSH level is 43 and normal is 0.4 - 4.5mlU/ L

2. Based on above clinical and laboratory data the patient is suffering from Hypothyroidism.Hypothyroidism also called underactive thyroid or low thyroid disorder of endocrine system in which thyroid gland does not produce enough thyroid hormone. Hypothyrodism is a primary disorder because it is caused due to disease in the thyroid and high TSH levels.

3.The auto immune disease which is caused by Hypothyroidism is Hashimoto thyroidits or chronic lymphocytic thyroiditis. Antibodies are formed against anti Tg ( thyroglobin). anti TPo ( thyroperoxidase) . All follicles are destroyed eventually T3 and T4 levels would be less. However high concentration of TSH is observed. Condition of Hypothyrodism also called Gull´s disease.

4. Abnormal glucose, lipid panel and creatinine are all symptoms of hyperlipidemia and Hypothyroidism  is a secondary cause of Hyperlipidemia and coronary heart disease. thats why the old women are treating for Hyperlipidemia.