Pagana: Mosby\u2019s Manual of Diagnostic and Laboratory Tests, 6th Edition
\nThyroiditis
\nCase Studies
\nThe patient, a 23-year-old woman, has had a bout of flulike symptoms over the past few weeks.
\nMost recently, she has become increasingly tired. She is taking birth control pills to control her
\nmenses. Her anterior neck became painful during the past few weeks. The physical examination
\nresults reveal that her thyroid is diffusely enlarged and mildly tender.
\nStudies Results
\nRoutine laboratory tests Within normal limits (WNL)
\nTotal thyroxine (T4), p. 442 8 mcg\/dL (normal: 5\u201312 mcg \/dL)
\nFree T4 0.5 ng\/dL (normal: 0.8\u20132.7 ng\/dL)
\nFree T4 index 0.4 ng\/dL (normal: 0.8\u20132.4 ng\/dL)
\nTriiodothyronine (T3), p. 449 52 ng\/dL (normal: 70\u2013205 ng\/dL)
\nThyroxine-binding globulin (TBG), p.
\n440
\n12 mg\/dL (normal: 1.7\u20133.6 mg\/dL)
\nThyroid stimulating hormone (TSH),
\np. 434
\n32 microunits\/mL (normal: 2\u201310 microunits\/mL)
\nThyroid scanning, p. 780 Enlarged gland; normal shape, position, and function
\nof the thyroid gland. No areas of decreased or
\nincreased uptake
\nThyroid ultrasound, p. 838 Enlarged gland; normal shape and position of the
\nthyroid gland
\nThyroid antibodies
\nAntithyroglobulin antibody, p. 92 1:250 (normal: titer <1:100)
\nAntithyroid peroxidase antibody,
\np. 93
\n1:500 (normal: titer <1:100)
\nThyroid-stimulating
\nimmunoglobulins, p. 437
\nNegative
\nDiagnostic Analysis
\nTotal T4 measures protein-bound and unbound T4. Because the patient was taking birth control
\npills, her TBG was elevated; therefore, her total T4 was normal. Free T4 and FT4 index tests
\nmeasure unbound T4. When the free T4 and the FT4 index were measured, they were found to be
\nlow, indicating that the patient had hypothyroidism. The TSH level was elevated because of
\nprimary failure of the thyroid. The thyroid antibodies were elevated, indicating that the patient
\nhad Hashimoto thyroiditis. Her long-acting thyroid stimulator (LATS) levels were normal,
\ndiscounting Graves disease as a cause of her diffusely enlarged thyroid. Her thyroid ultrasound
\nand scan failed to show any localized, defined tumor.
\nThe patient was started on thyroid replacement therapy, and her TSH level returned to normal.
\nOver the next few weeks, she felt markedly better. Her thyroid pain and tiredness disappeared.
\nCase Studies
\nCopyright \u00a9 2018 by Elsevier Inc. All rights reserved.
\n2
\nCritical Thinking Questions
\n1. Why were the thyroid antibodies important in this patient\u2019s diagnosis?
\n2. What symptoms might she experience if too much thyroid replacement medication were
\nadministered?<\/p>\n
___________________________
\nThe thyroid antibodies were important in this patient’s diagnosis because they indicated the presence of Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an autoimmune disease where the body’s immune system attacks the thyroid gland, leading to inflammation and eventual destruction of the thyroid tissue. The elevated levels of antithyroglobulin antibody and antithyroid peroxidase antibody confirmed the presence of autoimmune thyroiditis and helped differentiate it from other causes of hypothyroidism. These antibodies are commonly seen in Hashimoto’s thyroiditis and can help in confirming the diagnosis.<\/p>\n
If too much thyroid replacement medication (thyroid hormone) were administered to this patient, she might experience symptoms of hyperthyroidism. Hyperthyroidism occurs when there is an excessive amount of thyroid hormone in the body. Symptoms of hyperthyroidism may include:<\/p>\n
Increased heart rate or palpitations
\nWeight loss or difficulty gaining weight
\nNervousness, anxiety, or irritability
\nTremors or shaky hands
\nHeat intolerance or increased sweating
\nIncreased appetite
\nChanges in menstrual patterns
\nFatigue or muscle weakness
\nSleep disturbances
\nIt is important to closely monitor thyroid hormone levels and adjust the dosage as needed to avoid overtreatment or undertreatment, as both can lead to undesirable symptoms and complications. Regular follow-up and thyroid function tests are necessary to ensure the optimal balance of thyroid hormone replacement.<\/p>\n","protected":false},"excerpt":{"rendered":"
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