Clinical Biochemistry: Question 1 a)
A comparison of the provided clinical results and the reference ranges suggests that it is highly likely that the patient was suffering from hyperthyroidism. The tests conducted to the patient, as well as the patients’ symptoms all, point out to the possibility of hyperthyroidism. As such, the possible disorder that the patient could be suffering from is Graves’ disease, which is a common cause of the excessive production of thyroid hormones, otherwise known as hyperthyroidism (Ross, 2017). The symptoms experienced by the patient could have resulted from the overproduction of the thyroid hormones by the thyroid glands. Therefore, it is vital to evaluate the symptoms, clinical results, and the reference ranges as evidence of the disorder.
First, the symptoms indicate that the patient could be suffering from Graves’ disease. Excessive production of the thyroid hormone in the body leads to an increased basal metabolic weight. In essence, hyperthyroidism makes the body to burn more energy even while at rest, which leads to loss of weight. The elevated heart rate, clinically called tachycardia, must have resulted from the hypermetabolic state caused by excess thyroid hormones in the body (Ertek & Cicero, 2013). The excessive moistness of the skin, which is also a symptom of hyperthyroidism, is attributed to the increased blood cutaneous blood flow caused by tachycardia (Afsaneh, 2020). As for the enlargement of the thyroid gland, the antibodies produced to attacked the thyroid gland and made it produce excess thyroxine (Osuna et al., 2017). This also explains the presence of autoantibodies to the TSH in the serum. The effect of this overstimulation is the swelling of the thyroid gland, known as goiter.
The patient’s clinical results for the thyroid-stimulating hormone (TSH) were low (at a reference range of 0.3-4.0). Generally, the test measures the amount of TSH in the blood, so the patient could be experiencing hyperthyroidism since it is associated with low TSH levels. Park et al. (2017) state that pituitary glands produce the TSH hormone, and the clinical result of a low blood TSH reference range means that the thyroid gland is overproducing the hormone on its own. Noteworthy, patients with hyperthyroidism have all their thyroid hormone tests high, except for the TSH test, in which a lower reference range of TSH implies hyperthyroidism.
The other two essential clinical tests that indicate the possibility of hyperthyroidism are the free thyroxine (FT4) and the free tri-iodothyronine (FT3) tests. Starting with the FT4 test, it is clear that the reference ranges were higher than the typical ranges. T4 is the major hormone that the thyroid gland produces, and clinicians measure the blood levels as FT4, which is not bonded to protein (Strich et al., 2016). The elevated level of the FT4 in the patient’s clinical test results indicate hyperthyroidism. Similarly, the clinical officers also conduct the FT3 test to determine the normal functioning of the thyroid (Li et al., 2014). Essentially, the reasoning behind the higher levels of T3 and T4 is that the TSH stimulates the thyroid to produce these hormones, and hyperthyroidism leads to even excessive production of the same.
Question 1 b)
According to Gorman et al., 2017, Tropic hormones are hormones from the anterior pituitary glands that act on the endocrine glands by inducing them to secrete other hormones. Examples of the tropic glands include the thyroid-stimulating hormone, luteinizing hormone, and the follicle-stimulating hormone (FSH). As such, the anterior pituitary glands play a significant role in regulating the functioning of the endocrine system through the production of the tropic hormones. Upon their secretion, the target tropic hormones work by inducing the target organs to produce a physiologic response, mostly involving the secretion of other target hormones (Gorman et al., 2017). The secreted hormones affect the functioning of the anterior pituitary as well as the endocrine, thereby helping in the maintenance of the integrated feedback control system. Also, these tropic hormones can be useful in the investigation of endocrine disorders.
One known concept of the endocrine disorders is that they are caused by either overproduction or underproduction of a specific hormone. Overproduction occurs when there is hyperplasia in the organ responsible for the secretion of a particular hormone, or any other processes that can lead to overproduction (Tsaltas, 2016). Conversely, underproduction results from the destruction of the glands responsible for secreting the target hormones, or any other conditions that hinder the normal trophic influence of an organ. Both underproduction and overproduction of hormones lead to endocrine disorders. That said, investigating the endocrine disorders with reliance on the tropical hormones would imply that clinical officers appreciate the role of these hormones in ensuring the normal functioning of the endocrine system.
Clinical officers can use tropic hormones to investigate endocrine disorders through understanding the normal hormone levels of the tropic hormones and comparing them against the laboratory values of patients suspected to be having endocrine disorders. An excellent example of how clinical officers can investigate endocrine disorders using tropical hormones is in question 1 above. Using that as an example, the average levels of the hormones are known. The hypothalamus releases the thyroid-releasing hormone (TRH). TRH stimulates the pituitary glands to release the thyroid-stimulating hormone (TSH), which stimulates the thyroid gland to produce T3 and T4. With such concise knowledge of the tropic hormones, clinical officers can now start their investigation on any endocrine disorder.
Since clinical officers know the normal levels of the hormones, what follows is taking tests of those hormones from the patients. Still using our example, in which T4 and T3 tests will have to be conducted, as well as the TSH test. If the patient record higher or lower levels of these hormones, then there is a likelihood of an endocrine disorder, just as aforementioned. In the example, higher levels of T4 and T3 would imply that there is a disorder arising from the secretion of TSH. Elevated levels of T4 and T3 would typically cause a lower TSH. However, if the T4 and T3 tests turn lower, then clinical officers would expect the TSH test to be higher. Knowing the normal hormone levels and the pathways taken when tropic hormones induce other organs to secrete hormones is essential for such investigations. Summarily, through having a working knowledge of the processes that regulate normal hormonal levels, it is possible to investigate endocrine disorders using tropic hormones.
Afsaneh, K., 2020. Thyroid Disorders And Skin Problems. [online] News-Medical.net. Available at: https://www.news-medical.net/health/Thyroid-Disorders-and-Skin-Problems.aspx [Accessed 20 May 2020].
Ertek, S. and Cicero, A.F., 2013. Hyperthyroidism and cardiovascular complications: a narrative review on the basis of pathophysiology. Archives of medical science: AMS, 9(5), p.944.
Gorman, L.S. and Chiasera, J.M., 2013. Endocrinology review-adrenal and thyroid disorders. Clinical Laboratory Science, 26(2), p.107.
Li, H., Yuan, X., Liu, L., Zhou, J., Li, C., Yang, P., Bu, L., Zhang, M. and Qu, S., 2014. Clinical evaluation of various thyroid hormones on thyroid function. International journal of endocrinology, 2014.
Osuna, P.M., Udovcic, M. and Sharma, M.D., 2017. Hyperthyroidism and the Heart. Methodist DeBakey cardiovascular journal, 13(2), p.60.
Park, S.Y., Park, S.E., Jung, S.W., Jin, H.S., Park, I.B., Ahn, S.V. and Lee, S., 2017. Free triiodothyronine/free thyroxine ratio rather than thyrotropin is more associated with metabolic parameters in healthy euthyroid adult subjects. Clinical endocrinology, 87(1), pp.87-96.
Ross, D.S., 2017. Diagnosis of hyperthyroidism. UpToDate, Waltham, MA. Accessed, 20.
Strich, D., Karavani, G., Edri, S. and Gillis, D., 2016. TSH enhancement of FT4 to FT3 conversion is age dependent. Eur J Endocrinol, 175(1), pp.49-54.
Tsaltas, T., 2016. Selected endocrine disorders. Office Care of Women, p.349.
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