Question

1.Describe in detail the pathophysiology for anemia and hypothyroidism.
2.Findout if any,Relationship between anemia and hypothyroidism when pateint have lung cancer in detail.

Answer 1

1. The pathophysiology of Anemia according to the cause of the disease is :-

* Hypoproliferative Anemia

- Decreased erythrocyte production : There is decreased erythrocyte production, reflected by an inappropriately normal or low reticulocyte count.

- Marrow damage : As a result of marrow damage, inadequate production of erythrocyte occur due to the Medications or chemical or from a lack of factors.

* Hemolytic Anemia

- Premature destruction : Premature destruction of erythrocytes results in the liberation of hemoglobin from the erythrocytes into the plasma.

- Conversion : The released hemoglobin is converted in large part to bilirubin, resulting in high concentration of bilirubin.

- Erythropoietin production : The Increased erythrocyte destruction leads to tissue hypoxia which stimulates Erythropoietin production.

- Increased reticulocytes : This Increased production is reflected in an increased reticulocyte count as the bone marrow responds to the loss of erythrocytes.

- Hemolysis : Hemolysis is the end result, which can result from an abnormality with in the plasma, or from direct injury to the erythrocyte within the circulation.

Pathophysiology of Hypothyroidism

The most common cause of Hypothyroidism is the inability of the thyroid gland to produce a sufficient amount of thyroid hormone, however, less commonly pitutary and hypothalamus may also result in thyroid dysfunction. The hypothalamus secretes thyrotropin-releasing hormone ( TRH) that stimulates the pitutary gland to produce thyroid stimulating hormone ( TSH ) . Thyroid stimulating hormone stimulates the thyroid gland to produce and secrete mainly T4 and smaller quantities of T3. The half life of T4 is 7-10 days , and eventually T4 is converted to T3 peripherally by 5- deiodination. Levels of T3 majorly and T4 to some extent, in turn, exert negative feedback on the production of TRH and TSH. Alteration in the structure and function of any of these organs or pathways can result in hypothyroidism.

The decline in the production of T4 results in an increase in the secretion of TSH by the pitutary gland, causing hypertrophy and hyperplasia of the thyroid parenchyma, thereby leading to increased T3 production.

2. The pattern of thyroid hormone metabolism in lung cancer is a tendency towards reduced T3 concentrations with significantly increased T4/T3 rations and modestly Increased 3,3',5' - triiodothyronine concentrations. The altered T4/T3 ratio particularly noticeable in patients with anaplastic tumors of small and large cell types, but not apparently related to detectable extrathoracic metastasis.

The Hypothyroidism can be potential causes of anemia.

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