A 67-year-old woman is referred for treatment of hyperlipidemia.Her cholesterol and triglycerides are high, despite treatment withlipid-lowering medication. She is noted to have hair loss andhoarseness to her voice. She also complains of cold intolerance andfatigue. The physician orders a BMP, lipid panel, and thyroidtesting 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. (1pt)
(2) Based upon the above clinical and laboratory data, does thispatient have hypothyroidism or hyperthyroidism? Is this a primary,secondary, or tertiary thyroid disorder? (3 pts)
(3) The physician suspects an autoimmune etiology. Name the mostlikely condition and a lab test the can help confirm this potentialdiagnosis. (2 pts)
(4) Explain why this patient has abnormal glucose, lipid panel,and creatinine results? (4 pts)
