Question

Case 1

Mrs. A is a 28-year-old woman married to her new husband for three years already. She’s eager to have a baby already. She has 4 children with the first marriage. History reveals that she’d been having infections in her reproductive system in her previous marriage. She has regular menstruation with three days duration of moderate to heavy flow. There are no accompanying manifestations. She likewise had been infected with sexually transmitted disease since her previous husband was unfaithful to her for several times. She was given injections to treat her. So Since then she had regular follow-up with her physician who is a gynecologist. After her second marriage, work-up was done on her husband, which turned out to be normal. She likewise has undergone procedures to determine the patency of her tubes. She was told that that her tubes got inflamed which scarred blocking the tubes.

1.. Why should the client undergo the procedure to determine the patency of the tubes?

2. What histological features could have been affected by the inflammation in the previous years?

3. Why is Mrs. A based on the history and your assumptions, cannot or has difficulty of bearing a child based on her history?4. Aside from the inflammation of the tubes, what possible problem can arise that will make Mrs. A risks her life?

4. Why?

Case 2:

1. Interpret the following results of a 53-year-old woman who complained of

memory loss: the serum T4 concentration is 3.8 ug/dl (n=4.5-12.5), the serum

TSH is 23.0 uU/ml (n=0.2-3.5), and the serum cholesterol is 255 mg/dl (n<200). Is

this hyperthyroidism or hypothyroidism? Explain your answer.

Answer 1

Case 1

1) Repeated infections in her reproductive system can lead to chronic inflammation and scarring of the fallopian tubes leading to tubal factor infetility. So, it is mandatory to check the patency of the fallopian tubes to rule out tubal factor infertility.

Also, if there is a block in the fallopian tube, the fertilised ovum can not travel down to the uterus causing an ectopic pregnancy in the fallopian tubes.

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2) Histological features of chronic inflammation (chronic salpingitis) and blockage of the fallopian tubes can be seen in this case because of the repeated infections.

There can be evidence of chronic salpingitis like lymphocytic infiltrate of the walls, fibrotic lesions with thick walled tubes, luminal narrowing or complete obstruction.

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3) Mrs. A has difficulty of bearing a child because of 'Tubal factor infertility' i.e,  female infertility caused by damage, obstruction or scarringof the fallopian tube which prevents the descent of a fertilized or unfertilized ovum into the uterus through the fallopian tubes.

This is because of the history of reccurent infections of the reproductive system, and also the tubal patency tests showing inflammation and blockage of the tubes.

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4) The other problem that will make Mrs. A risks her life is later development of Cervical cancer. Because, there is history of multiple sexually transmitted infections, there is possibility of infection with Human papilloma virus (HPV) which is a strong risk factor for the development of cervical cancer.

Another possible complication is Ectopic pregnacy i.e, since there is a block in the fallopian tube, the fertilised ovum can not travel down to the uterus causing a pregnancy in the fallopian tubes. which can lead to tubal rupture and bleeding.

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Case 2

The thyroid hormones T3 and T4 are secreted by the Thyroid gland upon stimulation by the Thyroid stimulating hormone (TSH) secreted by the anterior pituitary gland. This secretion of TSH by the pituitary is regulated by the T3 and T4 levels by a feedback inhibition. i.e, high levels of T3 and T4 (Hyperthyroidism) will inhibit TSH production and low levels of T3 and T4 (Hypothyroidism) can stimulate TSH production.

Primary hypothyroidism is due to disease in the thyroid gland. Here, the levels of T3 and T4 are low which stimulates TSH release so that thyroid-stimulating hormone (TSH) levels are high .

Secondary hypothyroidism is due to pituitary or hypothalamic disease, where TSH levels are low. As a result there is no stimulation of the thyroid gland. So the T3 and T4 levels are low.

In case 2,

Serum T4 - 3.8 ug/dl (n=4.5-12.5)

Serum TSH - 23.0 uU/ml (n=0.2-3.5)

Here, the levels of Thyroid hormone T4 is below the normal range. As a result of this, there is stimulation of the anterior pituitary to release more of the Thyroid stimulating hormonr (TSH). This caused the TSH to be more than normal range. Here, the problem is in the Thyroid gland and the pituitary stimulation is normal.

So, this is a case of Hypothyroidism - Primary hypothyroidism.