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- Thu Jul 26, 2007 3:49 am
Patient: 54 years old female
26.06.2007 – Blood analysis
Hb - 66 (Norm 120-150)
Erythrocytes - 110.0 (Norm 72-90)
Erythrocytes (X 1012 L) - 4.0 (Norm 4.0-4.5)
Color index - 0.82 (Norm 0.85-0.95)
Leukocytes (X 109 L) - 8.0 (Norm 4.0-6.0)
Stab neutrophils - 6 (Norm 1-4.5)
Mature neutrophils - 67 (Norm 50-70)
Eosinophils - 3.5 (Norm 2-4.5)
Monocytes - 2 (Norm 4-8)
Lymphocytes - 21.5 (Norm 20-35)
Thrombocytes % - 80% (Norm 50-80)
Thrombocytes (X 109 L) - 320.0 (Norm 150-400)
ESR (mm/h) - 18 (Norm 4-16)
Prothrombin % - 75 (Norm 80-100)
29.06.2007 – CT
MR investigation of brain in sagital, coronal and axial sections by application of T1tse, T2tse, tirm, DWI, fl2d-hemo, T1tse fat sat regimes. On obtained tomograms in both-side frontal-sincputal lobe on the level of semi-oval centers, in paraventricular and subcortical white substance plural small sized hyper intensive areas (T2tse, tirm) were revealed, which corresponds to (old) nodes of encephalopathy. Lateral ventricles are symmetrical, without dilatation. Third ventricle – moderately dilated. Fourth ventricle - at medial line. Basal cisterns without deformation. Convexial subarachnoid areas in both-side frontal-sincputal lobe is moderately enlarged, cortical atrophy changes are manifested. Lateral displacement of middle structures is not revealed. Sella turcica is revealed with through, even contours. Hypophysis of homogenous structure and size of 12.3-8.7-5.1 mm. Neuro and adenohypophysis are differentiated well. Funnel at middle axis. Supraselar cistern without deformation. Orbits, optic chiasm and retrobulbar areas without obvious pathology. Paranasal sinuses are pneumatized. Conclusion: By MR investigation encephalopathy areas in both-side frontal-sincputal lobe are revealed. Cortical atrophies. Consultation of neurologist is recommended.
11.07.2007 – IFA
TSH - 39.47 IU/ml (Norm 0.4-4.0)
FT-3 - 1.57 pg/ml (Norm 1.8-4.2)
FT-4 - 0.51 ng/dl (Norm 0.8-2.0)
Anti-Thyroid Peroxidase - 1,958.07 IU/ml(Norm 0-40.0)
Anti-Thyroid Thyroglobulin - 3,032.95 IU/ml
11.07.2007 – Ultrasound investigation
Thyroid gland – horseshoe-shaped.
Sizes: Right lobe – 17 x 14 x 51 mm, volume (mass) – 5.8 cm3
Left lobe – 21 x 15 x 51 mm, volume (mass) – 7.6 cm3
Isthmus – 10 x 5 mm, total mass – 30-13.4 cm3 (N 12-18 cm3)
Structure: inhomogeneous, low echogenity, the obvious lobular structure and linear fibrous inclusions can be revealed. In right lobe calcification with size 5 mm is observed. In left lobe node with size 11 x 6 mm. Conclusion: Autoimmune thyroiditis (Hashimoto’s thyroiditis).
13.07.2007 – Consultation with endocrinologist
Diagnosis: Chronic autoimmune thyroiditis, primary hypothyreosis - hard form, decompensated, untreated.
Prescribed treatment: treatment by thyroxin drugs is necessary, but taking into account patient’s complaints regarding thyroxin intolerance treatment was prescribed with especial caution: starting doze (12 mkg) of drug (euthyrox-50 or L-thyroxin50) was determined as 12 mkg. The doze shall be increased by 12 mkg after every 10 days and reach 100 mkg at 29 September, 2007 (date of next consultation). The drug shall be obtained in combination with prednisolon.
Questions: What can be recommended to the patient?
| Dr. Chan Lowe
- Sat Aug 04, 2007 9:30 pm
Autoimmune thyroiditis (Hashimoto's thyroiditis) is very common and typically ends in hypothyroidism as it has in this patient.
Treatment is essentially to replace the thyroid hormone using thyroxine. Generally the synthetic thyroxines work well. Some people use thyroxine from bovine or other sources.
Levels should be titrated upward until the TSH level becomes normal.
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