Dayyal Dg.

Dayyal Dg.

Clinical laboratory professional specialized to external quality assessment (proficiency testing) schemes for Laboratory medicine and clinical pathology. Author/Writer/Blogger

Why is this test performed?

  1. The test is performed for the diagnosis of prostatic carcinoma by the estimation of total acid phosphatase (TAP) and the prostatic component.
  2. The test is also performed for the examination for the presence of semen in medicolegal cases by a vaginal swab. Due to the high level of acid phosphatase in semen, its presence indicates recent sexual intercourse. Level of ≥50 U/sample is considered as positive evidence of semen.

Collection of Sample

For the test of total acid phosphatase (TAP) and the prostatic acid phosphatase (PAP), morning sample is preferred. About 3 to 5 ml blood is collected in a vacutainer and blood is allowed to clot. Then blood is centrifuged for 10 minutes at 4500 rpm in order to get the clear serum. The test is performed immediately. However, the sample can be preserved for 24 hours if kept at 2-8º C.

See: Procedures for the collection of blood for hematological investigations

Precaution

  1. The sample has very poor stability in the whole blood, therefore serum is separated immediately and the test is performed within an hour.
  2. The sample is unstable for the test of ACP if the pH is more then 7.0.
  3. The sample is unstable for the test of ACP at room temperature (> 37º C).
  4. Hemolyzed serum causes the false-positive result. Increased values can be observed in hemolyzed serum.

Normal Values

  • Total acid phosphatase (TAP)
    2.5 to 3.7 ng /mL
    or < 3.0 mg /L
  • Prostatic acid phosphatase (PAP)
    < 2.5 ng/mL (0 to 0.6 U/L)
  • Other references
    Adult: 0.13 to 0.63 units/L at 37° C or 2.2 to 10.5 units/L (SI units)
    Child: 8.6 to 12.0 units/mL at 30° C
    Newborn:10.4 to 16.4 units /mL at 30°C

Reasons for the increased level

  1. Prostatic carcinoma
  2. Prostatitis
  3. Benign prostatic hyperplasia
  4. Metastatic carcinoma of the prostate
  5. Metastases to the bones

Moderately raised level seen in, other than prostatic carcinoma

  1. Hyperparathyroidism
  2. Niemann-Pick disease
  3. Sickle cell anemia
  4. Prostatitis and Benign prostatic hyperplasia ( BPH )
  5. Any cancer that has given metastasis to the bones.
  6. Urinary retention
  7. Multiple myelomas
  8. Myeloid Leukemia
  9. Paget disease
  10. Liver diseases like cirrhosis
  11. Renal diseases
  12. Thrombocytosis
  13. Gaucher’s disease

The significance of acid phosphatase test in medicolegal cases

Due to the high level of acid phosphatase in semen, its measurement is very important in rape cases. For the collection of a sample from the victim's body, following methods are applied.

  1. Direct aspiration or saline lavage
  2. Vaginal swab is obtained from the victim's vagina, and the sample is placed in 2.5% broth and can preserve at 4° C.

The significance of acid phosphatase test for the layman

  1. The test is performed for the diagnosis of prostatic carcinoma.
  2. This is carried out in cases of alleged rape or sexual assault.

Purpose of the test

The test is performed to assess the adrenal cortex function, and evaluate and monitor the adrenal tumors and hyperplasia.

How to collect the urine sample for the 17-ketosteroids test?

  1. For the test of 17-ketosteroids in urine, 24 hours urine sample is required. Urine is collected in a container, containing one gram boric acid or 6 ml hydrochloric acid (HCl).
  2. The first urine sample is discarded and then collected the all urine sample for 24 hours.
  3. The 24 hours urine sample is transferred to the pathology laboratory for laboratory findings.

Why is boric acid used for the collection of the urine sample?

Boric acid converts the urine into a bacteriostatic medium, which inhibits the growth of bacteria in urine and preserves the urine for its bacteriological examination.

Precautions

Some medicines like aspirin, diuretics, antibiotics, birth control medication and hormones therapy (e.g. Estrogen) may interfere with laboratory findings, so avoid such types of medicine before preparing yourself for the laboratory test.

Normal Values

  • Males: 8-20 mg/24-hour
  • Females: 6-15 mg/24-hour
  • Elderly males > 70 years: 3-12 mg/24-hour
  • Elderly females > 70 years: 3-13 mg/24-hour
  • Infants: < 1 mg/24-hour
  • 1 to 5 years: < 5 mg/24-hour

Reasons for the increased level of 17-ketosteroids in the 24-hour urine sample

  • Pregnancy
  • Stein-Leventhal syndrome
  • Hyperpituitarism
  • Ectopic ACTH-secreting tumors
  • Administration of ACTH
  • Cushing’s syndrome
  • Congenital adrenal hyperplasia 
  • Testosterone secreting or androgen-secreting tumors of:
    (1) Ectopic ACTH-secreting tumors
    (2) Ovaries
    (3) Testes

Reasons for the decreased level of 17-ketosteroids in the 24-hour urine sample

  • Hypopituitarism
  • Severe infections 
  • Klinefelter's syndrome
  • Addison’s disease
  • Severe stress
  • Nephrosis
  • Debilitating diseases
  • Chronic diseases
  • Castration
  • Myxedema
  • Drugs that can decrease the level of 17-ketosteroids include:
    (a) Probenecid
    (b) Estrogens
    (c) Reserpine
    (d) Thiazide diuretics
    (e) Salicylates (prolonged use)
    (f) Birth control pills

The significance of 17-ketosteroids for the layman

  1. The test is advised if the females has hairs on her face.
  2. The test is performed to elaborate any abnormality or disorders of the adrenal gland.

Anal sex refers to the activity in which penis is inserted into the anus. Some people found anal sex more joyful, but the fact is that the practice has the downside and it contains so many health risks.

It is prohibited in various cultures especially with regard to religious prohibition. It is a criminal offense in some countries and punishable by corporal or capital punishments. By disparity, people regard it a valid and natural form of sexual activity.

Is Anal Sex Safe?

There are so many health risks associated with the anal sex and anal intercourse, for both partners. Some of the health risks which may affect both homosexual and heterosexual couples are listed below.

Risk of bacterial infection: E. coli is a Gram-negative, facultative anaerobic bacteria, that is commonly found in the lower intestine. Anal sex increases the risk of transmission of E. coli bacteria from anal to your penis, which may cause a severe type of urinary tract infection.

E. coli may cause many bacterial infections, including, urinary tract infection (UTI), meningitis, cholecystitis, cholangitis, bacteremia, and pneumonia.

Hepatitis A Virus (HAV): Hepatitis A Virus can transmit by the oral sex (anal licking). HAV causes jaundice. It is usually not a life-threatening virus but may cause illness.

Hepatitis C Virus (HCV): It may be transmitted through the anal intercourse. Hepatitis C Virus is the cause of fetal liver chronic disease. It is a life-threatening virus and may lead to death.

Human Papilloma Virus (HPV): It may be transmitted through the anal intercourse and may cause to the anal wart. A research showed that some of the strain of HPV have carcinogenic potential. Some strains of HPV cause cancer of the cervix in women and also cause cancer of the throat.

Human immunodeficiency virus (HIV): There is a greater risk of transmission of HIV through anal intercourse. It is a life-threatening virus and leads to death.

Weakening of the anal sphincter: The anal anus is enclosed by the ring-like muscle, called the anal sphincter. The main function of anal sphincter is to hold the feces until you get to the toilet. After the excretion of feces, it tightens. Penetration of something like a penis inside the anal can be difficult and painful. Anal intercourse may lead to the weakening of the sphincter muscles, and make it hard to hold the feces.

Lack of natural lubrication: Naturally, the anal is not made for sex. The anal has lack of lubricant as vagina have, which makes the penetration harder and painful. Penetration can tear the tissues inside the anal and cause the wound, allowing viruses and bacteria to easily enter the bloodstream. Somehow, usage of oil or other lubricants can help in preventing the tearing of tissues inside the anal but doesn't completely.

A research showed that risk of transmission of HIV and HPV is much higher in anal sex and compared to the vaginal sex.

How to Prevent Anal Sex Problems

There is no way to completely eliminate the risk factors of anal sex until you avoid the anal sex. However, you can reduce the risk by the following tips.

  1. Always use a condom during anal sex.
  2. Do not enter penis into the mouth after inserting it into the anal.
  3. Use a sufficient amount of lubricants when penetrating into the anal to reduce the risk of tissue tear. Always use water-based lubricants with condoms.
  4. Do not lick the anal as it may cause the transmission of bacteria and viruses.
  5. Take a warm bath before anal sex.
  6. Lying on your stomach will make the insertion easier.
  7. Stop if you feel so much pain during anal sex.
  8. Stop if you experience bleeding or discharge coming from it, go to the hospital as soon as possible.
Sunday, 11 February 2018 09:35

TORSION AND DETORSION IN MOLLUSCA

TORSION
 
Torsion is a process in which the viscero-pallium rotates anti-clockwise through 180° from its initial position during larval development. So that the mantle cavity, with its pallial complex, is brought to the front of the body in the adult.
 
How Torsion Occurs
 
Torsion is not an evolutionary hypothesis. Its occurrence can be seen during embryogeny of living gastropods. Before torsion the larva is quite symmetrical, the mantle cavity is backward and downward, the alimentary canal is straight and anus opens posteriorly in the middle line. The shell and visceral mass originally saucer-shaped, which is first cone-shaped and then spirally coiled. When the shell lies dorsally and forms a coil anterior side then the shell is called exogastric.
 
The ventral flexure is followed by a lateral torsion, so that the dorsal or exogastric shell becomes a ventral or endogastric shell. The entire process takes 2 to 3 minutes as in Acmaea.
 
Torsion is actually effected due to the contraction of the larval retractor muscles, in which only the narrow neck of the larva is actually twisted. So the everything between the head and the anus undergoes an anti-clockwise rotation at the angle of 180°.
 
Thomson (1958) described five ways by which the torsion can be brought about.
 
  1. In Archaeogastropods, the Acmaea, the torsion takes place by muscles contraction alone.
  2. The rotation of 180° is completed in two stages, the first movement takes place by the contraction of larval retractor muscle and second rotation is slower by different growth. It is very common as in Patella, Haliotis etc.
  3. The rotation of 180° takes place by only differential growth processes like Vivapara.
  4. Rotation by differential growth processes, with anus coming to a position appropriate to the adult state like Aplysia.
  5. Torsion is no longer recognizable as a movement of viscera-pallium, the organs in the post-torsional position from their first appearance as in Adalaria.
 
Effects of Torsion
 
The effect of torsion first time indicated by Spengel in 1881. The effects are not equally examined in all the gastropods by the general effects are described as follows:
 
  1. Displacement of mantle cavity: The mantle cavity was primarily present on the posterior side. The elongation of the ventral foot which was primarily very small. After torsion, the mantle cavity opens just behind the head and its associated parts are shifted forwards.
  2. Changes in relative position: Before torsion, the anus, ctenidia and excretory opening were placed on the posterior side and the auricles were placed behind the ventricle but after torsion the anus, ctenidia and excretory opening become anterior and the auricles lie in front of the ventricle. The original posterior face of the visceral sac becomes the anterior face so that the visceral organs morphologically of the original right side change into the left side.
  3. Looping of alimentary canal: The alimentary canal which was originally straight from mouth to anus, after torsion, it changes into a loop.
  4. Chiastoneury: The long, uncoiled pleuro-visceral nerve connectives become a figure of "8" after twisting. The right connective with its ganglion passes over the intestine to form the supra-intestinal connective, while the next connective pass under the intestine to form the infra-intestinal connective.
  5. Endogastric coil: The coil of visceral sac and shell, which was primarily dorsal or exogastric become ventral and endogastric after torsion.
  6. Loss of Symmetry of Atrophy: The anus changes their original position towards the right side of the pallial cavity so that the original symmetrical condition disturbed.
 
DETORSION
 
The torsion is reversible in Eu-thy-neura and its reversal is known as detorsion by which animal become untwisted and symmetrical.
Tuesday, 06 February 2018 14:42

PROCESS OF FORMATION OF PEARL IN MOLLUSCS

The “pearl” is literally formed by the mantle epithelium, which becomes deposit around any external body or particles, these external particle or body invade in between the shell and mantle in any way.

Pearl is secreted by the mantle as a means of protection against a small external particle. When an external particle or body, such as a grain of sand or a small parasite invades in between the mantle and the shell it becomes enclosed in a sac of mantle epithelium which produces irritation. The irritation stimulates the mantle epithelium to secrete thin concentric layers of mother of pearl around the foreign body. The amount of deposition is in direct proportion to the degree of irritation. After several years, a pearl will be formed, usually, it requires 3 to 4 years to produce a pearl of considerable size but a large pearl requires about 7 years. The foreign particles in the pearl are called nucleus whereas the thin nacre layers are concentric and called the mother of pearl.
 
Pearls are formed by various clams and oysters, but those produced by the marine pearl oysters, Meleagrina of Eastern Asia are the most valuable.
 
Formation of Pearl
 
 
Tuesday, 30 January 2018 07:35

HOW TO REMOVE BLACKHEADS AT HOME

Blackheads are the most common problem in the majority of people. This problem arises when the oily secretion of the sebaceous glands forms a blockage in your skin pores. When the oil is exposed to air, it oxidizes and turns into black and forms blackhead. So the question is that how you can remove blackheads from your skin.
 
Removing of blackheads from your skin is very simple and you can do this at home, all you need to do is remove the entire blockage from your skin pores.
 
In order to remove the blockage from your skin pores, you need the following material.
 
  1. Towel or soft cloth
  2. Blackhead removal strips or pads
  3. Salicylic acid (C7H6O3)
 
Step 1
 
Wash your skin with the slightly hot water, and gently compress your skin pores with the help of towel or soft cloth. The warmth will open the pores of your skin and make it easier to remove the blockage caused by secretion of the sebaceous glands and to get rid of blackheads. Follow this step upto 5 times.
 
Step 2
 
Apply a blackhead elimination strip or pad to your face while your skin pores are still moist from the compress done in step 1. The moisture to your pores and skin will help the blackhead removal strip cohere on your skin and blackheads. Allow 10 to 15 minutes for the blackhead removal strip to stick itself.
 
After 10 to 15 minutes, pull the strip off. It should remove the blockage and blackheads from your skin pores in a different level of success. But in some cases, it removes the entire blockage and blackheads; in other situations, only the head of the blockage is ripped from the pores of the skin.
 
Step 3
 
With the help of your fingertips, squeeze your skin gently to remove the blackheads from your skin. Note that fingernails should not be used for that purpose as it may harm your skin. If they do not pop out effortlessly, do not squeeze harder as it may harm your skin. Rather, try making use of warmth compress and squeezing another time straight away after removing the warm compress.
 
If the blackheads do not pop out by this method, they probably cannot be removed adequately with your fingers.
 
Step 4
 
Salicylic acid (C7H6O3) is a medication most commonly used for the skin treatment. It removes the outer layer of the skin and most commonly used for the treatment of calluses, dandruff, acne, ringworm, warts, psoriasis and ichthyosis.
 
Apply a thin layer of salicylic acid liquid or paste onto your skin and leave it for a minute. After the use of salicylic acid, do another hot compress and try to squeeze out the remaining extra blackheads.
 
MODE OF ACTION: When you apply the layer of salicylic acid liquid onto your skin, it breaks down the sebum oil and can get deep into your skin pores where your fingers cannot.
You can compare the deionized water vs distilled water, however, to mention that the distilled water is that the same as deionized water may be a mistake. The terms “distilled water” and “deionized water” are usually misunderstood. during this article, you'll notice the reason to grasp the variations and similarities of those 2 completely different water cleanup technologies.
 
DISTILLED WATER
 
The oldest technique for production of pure water is that the thermal technique or distillation – water evaporation from the surface and condensation. the premise of the method is that the transfer of water within the vapor section with its later condensation. the most downside of this technique is that the terribly high maintenance prices of the electricity required to convert the water into the steam. additionally, within the method of steam formation in conjunction with water molecules, alternative solutes will enter the steam in keeping with their volatility. Evaporation is achieved in varied ways: the vacuum on top of the water, heating, etc.
 
Let’s contemplate the distillation. What’s happening within the method of distillation? The water molecules have the boiling purpose of 100°C or 212° F. alternative substances have completely different boiling points. The substance that boils at a lower temperature evaporates initial. The boiling purpose of assorted impurities is higher, and, in theory, they're going to begin to evaporate, once the water has already cooked out. The substance that boils at a lower temperature evaporates initial. because of this distinction the water is separated.
 
As a result, in theory when the distillation the fully pure water is obtained. Actually, organic substances, that have the similar boiling purpose than that of water will supply the water. let's say if the water contains the oil drops they will be found additionally within the liquid. There area unit much no salts within the water, as a result of the salt boils at a far higher temperature. To eliminate the matter of organic substances, the water distillers have pre- and post water filters.
 
The absolute advantage of the water is that the complete absence of harmful substances.
 
REVERSE OSMOSIS (RO) WATER
 
The latest various to the thermal technique for getting of water may be a two-stage reverse diffusion. The technology relies on the double passage of raw water through a tissue layer beneath the pressure. As a result, water is split into 2 streams: the filtrate (purified water) and concentrate (a targeted resolution of impurities). The two-stage reverse diffusion system will considerably cut back operational prices and improve the standard of obtained water. The reverse diffusion water treatment technology is that the most typically employed in households and within the trade for preparation of drinkable.
 
DEIONIZED (DI) WATER
 
Deionized water is deeply demineralized, ultrapure water with the impedance on the point of eighteen megohm-cm. it's employed in electronics, computer circuit boards, instrument manufacture, pharmacy, laundry liquids, etc.
 
In order to get the top quality pure deionized water, a multi-stage water purification method is used. when pre-cleaning, the water is equipped with the reverse diffusion membrane, so the water is filtered through a special deionization medium, that removes the remainder of the ions from the water. The purity of deionized water will exceed the purity of water.
 
SIMILARITIES AND DIFFERENCES: DISTILLED WATER Vs RO WATER Vs  DEIONIZED WATER 
 
 DISTILLED WATER REVERSE OSMOSIS (RO) WATER DEIONIZED (DI) WATER
Distillation is employed in the main in laboratories and factories, wherever it's required. Reverse diffusion is widely employed in water treatment plants, each reception and for the manufacture of assorted drinks, drinking water, etc.
  • RO water is additional saturated with salts and atomic number 8 then the water and DI water.
  • Reverse osmosis and deionization are more cost-effective than the distillation.
DI water is as pure because the water or maybe purer

 

Distillation, RO and deionization processes are supposed to purify the water of the contaminants: mercury, lead, strontium, nitrates, phosphates, manganese, in addition, pesticides.
 

Green tea is frequently touted as one of the most beneficial drink alternatives. Similarly, as with different sorts of tea, green tea originates from Camellia sinensis plant clears out. Be that as it may, contrasted and dark tea, green tea brings down in caffeine and has a high epigallocatechin gallate content. Green tea is positively more advantageous than sugary soda pops, yet regardless you hazard symptoms from this refreshment. Such dangers may even incorporate lifted pulse, additionally called hypertension.

Thursday, 28 September 2017 09:23

TOTAL THYROXINE (T4)

Total serum thyroxine includes both free and protein-bound thyroxine and is usually measured by competitive immunoassay. Normal level in adults is 5.0-12.0 μg/dl.
 
Test for total thyroxine or free thyroxine is usually combined with TSH measurement and together they give the best assessment of thyroid function.
 
Causes of Increased Total T4
 
  1. Hyperthyroidism: Elevation of both T4 and T3 values along with decrease of TSH are indicative of primary hyperthyroidism.
  2. Increased thyroxine-binding globulin: If concentration of TBG increases, free hormone level falls, release of TSH from pituitary is stimulated, and free hormone concentration is restored to normal. Reverse occurs if concentration of binding proteins falls. In either case, level of free hormones remains normal, while concentration of total hormone is altered. Therefore, estimation of only total T4 concentration can cause misinterpretation of results in situations that alter concentration of TBG.
  3. Factitious hyperthyroidism
  4. Pituitary TSH-secreting tumor.
 
Causes of Decreased Total T4
 
  1. Primary hypothyroidism: The combination of decreased T4 and elevated TSH are indicative of primary hypothyroidism.
  2. Secondary or pituitary hypothyroidism
  3. Tertiary or hypothalamic hypothyroidism
  4. Hypoproteinaemia, e.g. nephrotic syndrome
  5. Drugs: oestrogen, danazol
  6. Severe non-thyroidal illness.
 
Free Thyroxine (FT4)
 
FT4 comprises of only a small fraction of total T4, is unbound to proteins, and is the metabolically active form of the hormone. It constitutes about 0.05% of total T4. Normal range is 0.7 to 1.9 ng/dl. Free hormone concentrations (FT4 and FT3) correlate better with metabolic state than total hormone levels (since they are not affected by changes in TBG concentrations).
 
Measurement of FT4 is helpful in those situations in which total T4 level is likely to be altered due to alteration in TBG level (e.g. pregnancy, oral contraceptives, nephrotic syndrome).
 
Total and Free Triiodothyronine (T3)
 
Uses
 
  1. Diagnosis of T3 thyrotoxicosis: Hyperthyroidism with low TSH and elevated T3, and normal T4/FT4 is termed T3 thyrotoxicosis.
  2. Early diagnosis of hyperthyroidism: In early stage of hyperthyroidism, total T4 and free T4 levels are normal, but T3 is elevated.
 
A low T3 level is not useful for diagnosis of hypothyroidism since it is observed in about 25% of normal individuals.
 
For routine assessment of thyroid function, TSH and T4 are measured. T3 is not routinely estimated because normal plasma levels are very low.
 
Normal T3 level is 80-180 ng/dl.
 
Free T3: Measurement of free T3 gives true values in patients with altered serum protein levels (like pregnancy, intake of estrogens or oral contraceptives, and nephrotic syndrome). It represents 0.5% of total T3.
 
Thyrotropin Releasing Hormone (TRH) Stimulation Test
 
Uses
 
  1. Confirmation of diagnosis of secondary hypothyroidism
  2. Evaluation of suspected hypothalamic disease
  3. Suspected hyperthyroidism
 
This test is not much used nowadays due to the availability of sensitive TSH assays.
 
Procedure
 
  • A baseline blood sample is collected for estimation of basal serum TSH level.
  • TRH is injected intravenously (200 or 500 μg) followed by measurement of serum TSH at 20 and 60 minutes.
 
Interpretation
 
  1. Normal response: A rise of TSH > 2 mU/L at 20 minutes, and a small decline at 60 minutes.
  2. Exaggerated response: A further significant rise in already elevated TSH level at 20 minutes followed by a slight decrease at 60 minutes; occurs in primary hypothyroidism.
  3. Flat response: There is no response; occurs in secondary (pituitary) hypothyroidism.
  4. Delayed response: TSH is higher at 60 minutes as compared to its level at 20 minutes; seen in tertiary (hypothalamic) hypothyroidism.
 
Antithyroid Antibodies
 
Box 864.1 Thyroid autoantibodies
 
  • Useful for diagnosis and monitoring of autoimmune thyroid diseases.
  • Antimicrosomal or antithyroid peroxidase antibodies: Hashimoto’s thyroiditis
  • Anti-TSH receptor antibodies: Graves’ disease
Various autoantibodies (TSH receptor, antimicrosomal, and antithyroglobulin) are detected in thyroid disorders like Hashimoto’s thyroiditis and Graves’ disease. Antimicrosomal (also called as thyroid peroxidase) and anti-thyroglobulin antibodies are observed in almost all patients with Hashimoto’s disease. TSH receptor antibodies (TRAb) are mainly tested in Graves’ disease to predict the outcome after treatment (Box 864.1).
 
Radioactive Iodine Uptake (RAIU) Test
 
This is a direct test that assesses the trapping of iodide by thyroid gland (through the iodine symporters or pumps in follicular cells) for thyroid hormone synthesis. Patient is administered a tracer dose of radioactive iodine (131I or 123I) orally. This is followed by measurement of amount of radioactivity over the thyroid gland at 2 to 6 hours and again at 24 hours. RAIU correlates directly with the functional activity of the thyroid gland. Normal RAIU is about 10-30% of administered dose at 24 hours, but varies according to the geographic location due to differences in dietary intake.
 
Causes of Increased Uptake
 
  • Hyperthyroidism due to Graves’ disease, toxic multinodular goiter, toxic adenoma, TSH-secreting tumor.
 
Causes of Decreased Uptake
 
  • Hyperthyroidism due to administration of thyroid hormone, factitious hyperthyroidism, subacute thyroiditis.
 
Uses
 
RAIU is most helpful in differential diagnosis of hyperthyroidism by separating causes into those due to increased uptake and due to decreased uptake.
 
Thyroid Scintiscanning
 
An isotope (99mTc-pertechnetate) is administered and a gamma counter assesses its distribution within the thyroid gland.
 
Interpretation
 
  • Differential diagnosis of high RAIU thyrotoxicosis:
    – Graves’ disease: Uniform or diffuse increase in uptake
    – Toxic multinodular goiter: Multiple discrete areas of increased uptake
    – Adenoma: Single area of increased uptake
  • Evaluation of a solitary thyroid nodule:
    – ‘Hot’ nodule: Hyperfunctioning
    – ‘Cold’ nodule: Non-functioning; about 20% cases are malignant.
 
Interpretation of thyroid function tests is shown in Table 164.1.
 
Table 864.1 Interpretation of thyroid function tests
Test results Interpretations
1. TSH Normal, FT4 Normal Euthyroid
2. Low TSH, Low FT4 Secondary hypothyroidism
3. High TSH, Normal FT4 Subclinical hypothyroidism
4. High TSH, Low FT4 Primary hypothyroidism
5. Low TSH, Normal FT4, Normal FT3 Subclinical hyperthyroidism
6. Low TSH, Normal FT4, High FT3 T3 toxicosis
7. Low TSH, High FT4 Primary hyperthyroidism
 
Neonatal Screening for Hypothyroidism
 
Thyroid hormone deficiency during neonatal period can cause severe mental retardation (cretinism) that can be prevented by early detection and treatment. Estimation of TSH is done on dry blood spots on filter paper or cord serum between 3rd to 5th days of life. Elevated TSH is diagnostic of hypothyroidism. In infants with confirmed hypothyroidism, RAIU (123I) scan should be done to distinguish between thyroid agenesis and dyshormonogenesis.

Among the endocrine disorders, disorders of the thyroid are common and are only next in frequency to diabetes mellitus. They are more common in women than in men. Functional thyroid disorders can be divided into two types depending on the activity of the thyroid gland: hypothyroidism (low thyroid hormones), and hyperthyroidism (excess thyroid hormones).

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