Answers to Thyroid Function Test (TFT), Case Analysis 3

CASE ANALYSIS 3

•      A 59 YEAR OLD MAN WHO HAS BEEN DIAGNOSED WITH ACUTE RESPIRATORY DISTRESS SYNDROME SHOWED SYMPTOMS OF HYPOTHERMIA, COOLNESS IN THE EXTREMITIES, DECREASED BLOOD PRESSURE AND PULSE, FATIGUE, AND DELAY IN REFLEX TIME.  A THYROID PROFILE WAS ORDERED WITH THE FOLLOWING RESULTS:

LABORATORY FINDINGS

•      FT4 = 4.0

•      s.-TSH = 1.0 uU/mL

QUESTIONS

•      1.  FROM THE CASE HISTORY AND THE LABORATORY DATA, WHAT IS A LIKELY DIAGNOSIS?

•      Possibly euthyroidism or hypothyroidism, but since s-TSH is normal, it might be borderline case or a physiological factor is present.

•      2.  WHAT ADDITIONAL LABORATORY TEST/S WOULD BE APPROPRIATE?

•      FT3, TT3, Stimulation tests, TBG, or perform a delta check (repeat tests)

•      3.  WHAT ADDITIONAL INFORMATION CONCERNING THE PATIENT WOULD BE HELPFUL IN INTERPRETING RESULTS?

•      Patient’s history, surgical procedures done, drugs taken

•      4.  IS TREATMENT FOR THYROID DISORDER INDICATED?

•      Observe first for a few weeks and wait for additional tests and delta checks.

Thyroid Function Test TFT), Case Analysis 3

CASE ANALYSIS 3

•      A 59 YEAR OLD MAN WHO HAS BEEN DIAGNOSED WITH ACUTE RESPIRATORY DISTRESS SYNDROME SHOWED SYMPTOMS OF HYPOTHERMIA, COOLNESS IN THE EXTREMITIES, DECREASED BLOOD PRESSURE AND PULSE, FATIGUE, AND DELAY IN REFLEX TIME.  A THYROID PROFILE WAS ORDERED WITH THE FOLLOWING RESULTS:

LABORATORY FINDINGS

•      FT4 = 4.0

•      s.-TSH = 1.0 uU/mL

QUESTIONS

•      1.  FROM THE CASE HISTORY AND THE LABORATORY DATA, WHAT IS A LIKELY DIAGNOSIS?

• 

•      2.  WHAT ADDITIONAL LABORATORY TEST/S WOULD BE APPROPRIATE?

•

•      3.  WHAT ADDITIONAL INFORMATION CONCERNING THE PATIENT WOULD BE HELPFUL IN INTERPRETING RESULTS?

•      4.  IS TREATMENT FOR THYROID DISORDER INDICATED?

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Answers to Thyroid Function Case Analysis 2 - Questions

TFT CASE ANALYSIS 2

•      1. A 41 YR OLD WOMAN COMPLAINED OF INCREASED SWEATING OVER THE PREVIOUS 3 MONTHS.  SHE ALSO STATED THAT SHE ALWAYS SEEMED NERVOUS AND HAD HEART PALPITATIONS AND HEAT INTOLERANCE.  SHE LOST 12 POUNDS OVER THE PAST 3 WEEKS AND HAD NONCRAMPING DIARRHEA.  ON EXAMINATION, HER SKIN WAS WARM AND MOIST, SHE HAD A PROMINENT STARE, AND SHE HAD TACHYCARDIA AT 140 BEATS PER MINUTE.  HER THYROID GLAND WAS DIFFUSELY ENLARGED WITH A SUGGESTION OF NODULARITY.

LABORATORY FINDINGS

•      TT4 = 21.2 ug/dL ( 273 nmol/L)

•      THBR RATIO = 2.0

•      s-TSH = NONE DETECTED

•      FT4I = 42.4 ng/dL ( 546 pmol/L)

QUESTIONS

•      1. WHAT IS THE MOST PROBABLE CAUSE OF THESE SYMPTOMS AND LABORATORY RESULTS?

Hyperthyroidism with goiter

•      2.  WHAT ADDITIONAL LABORATORY TESTING WOULD BE HELPFUL IN CONFIRMING THE DIAGNOSIS?

TT3 and FT3

•      3.  WHAT IS THE SIGNIFICANCE OF THE s- TSH TEST?

It is the most sensitive test to confirm hypothyroidism or hyperthyroidism

•      4.  WHAT CAUSES THE DISORDER?

Insufficient Iodine in the diet, dysfunctional thyroid gland

Thyroid Function Case Analysis 2 - Questions

CASE ANALYSIS 2

•      1. A 41 YR OLD WOMAN COMPLAINED OF INCREASED SWEATING OVER THE PREVIOUS 3 MONTHS.  SHE ALSO STATED THAT SHE ALWAYS SEEMED NERVOUS AND HAD HEART PALPITATIONS AND HEAT INTOLERANCE.  SHE LOST 12 POUNDS OVER THE PAST 3 WEEKS AND HAD NONCRAMPING DIARRHEA.  ON EXAMINATION, HER SKIN WAS WARM AND MOIST, SHE HAD A PROMINENT STARE, AND SHE HAD TACHYCARDIA AT 140 BEATS PER MINUTE.  HER THYROID GLAND WAS DIFFUSELY ENLARGED WITH A SUGGESTION OF NODULARITY.

LABORATORY FINDINGS

•      TT4 = 21.2 ug/dL ( 273 nmol/L)

•      THBR RATIO = 2.0

•      s-TSH = NONE DETECTED

•      FT4I = 42.4 ng/dL ( 546 pmol/L)

QUESTIONS

•      1. WHAT IS THE MOST PROBABLE CAUSE OF THESE SYMPTOMS AND LABORATORY RESULTS?

•      2.  WHAT ADDITIONAL LABORATORY TESTING WOULD BE HELPFUL IN CONFIRMING THE DIAGNOSIS?

•      3.  WHAT IS THE SIGNIFICANCE OF THE s- TSH TEST?

•      4.  WHAT CAUSES THE DISORDER?

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Answers to Thyroid Function Test Case Analysis

ANSWERS - CASE ANALYSIS 1

Given results of patient:

•                    Patient                                  Reference

•      T4, Total (S) 7.0 ug/dl                         5 - 11.5

•      T3 resin uptake (S) 19%                     25 - 35

•      T3, Total (S) 134 ng/dl                       100 - 215

•      Free thyroxine index (FTI) 4.3            6 - 11.5

•      TSH (S) 22.0 uU/ml                            0.7 - 7.0

•      Antithyroglobulin Ab. Pos. (1:640)    Neg. Antimicrosomal Ab. Pos. (1:5120)     Neg. Cholesterol (S) 230 mg/dl                   140 - 225

•      (S = analyzed in serum specimens)

ANSWERS TO QUESTIONS:

1.      What does the low T3Uptake mean?

There are many TBG with active present in the sample.

2.      How would you interpret the results?

The patient may be a pregnant woman suffering from hypothyroidism. The RT3U is low indicating increased TBG, which could be seen in pregnancy. The increased TSH could indicate hypothyroidism, because TSH acts as a confirmatory test for thyroid function.

Thyroid Function Test (TFT) Case Analysis

Laboratory Test Results: Given results of patient:

•                    Patient                                  Reference

•      T4, Total (S) 7.0 ug/dl                         5 - 11.5

•      T3 resin uptake (S) 19%                     25 - 35

•      T3, Total (S) 134 ng/dl                       100 - 215

•      Free thyroxine index (FTI) 4.3            6 - 11.5

•      TSH (S) 22.0 uU/ml                            0.7 - 7.0

•      Antithyroglobulin Ab. Pos. (1:640)    Neg. Antimicrosomal Ab. Pos. (1:5120)     Neg. Cholesterol (S) 230 mg/dl                   140 - 225

•      (S = analyzed in serum specimens)

QUESTIONS

1.      What does the low T3Uptake mean?

2.      How would you interpret the results?

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