Auto Antibodies to Thyroid Peroxidase

1. A 49-year-old woman
(5

2
′′
,170
lbs
)
comes to Accra Technical University clinic with a chief complaint of feeling poorly for the past few months. When asked for more details, she complains of a list of symptoms including fatigue, cold intolerance, weight gain, and constipation. Her physical appearance is normal except for a noticeable yellow tint to her skin, and puffiness of her face. Her thyroid gland appears firm and enlarged. Her lab tests indicate free thyroxine  Auto Antibodies to Thyroid Peroxidase
(FT4)=0.5ng/dL
(normal:
0.7−1.9

 

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);
TSH=70IU/ml
(normal: 0.5-4.7); thryoperoxidase antibodies
=140IU/L
(normal
<100
). Comment on these results. What is the most likely diagnosis? 2. A 24-year-old Med Lab student of Accra Technical University consulted the University sick bay doctor because excessive moistness of her skin was causing embarrassment at school. She was also concerned that her eyes seemed to have become more prominent and that she has lost weight, although her appetite was unchanged. On examination, the doctor observed that her pulse was
92/min
and at rest she had a slightly enlarged thyroid gland. Investigations
Serum: TSH
fT4
fT3 Auto Antibodies to Thyroid Peroxidase

<0.01mU/L
34pmol/1
12pmol/l

An isotope scan of the thyroid showed an enlarged gland, with uniformly increased uptake. Autoantibodies to thyroid peroxidase were present in the serum in high titre. Comment on the above results. 3. A 54-year-old woman arrives at the ATU Hospital Emergency Department with the chief complaint of chest pain unrelieved by nitroglycerin. She is given a chewable aspirin, her blood pressure and ECG are recorded, and a blood sample was taken for lab analysis. During the taking of her medical history she complains of recent bouts of heat intolerance, nervousness, chest palpitations, and weight loss (despite having an increased appetite). Her observed vital signs are: Blood Pressure of
170/90 mmHg
; Pulse
120/min
, Temperature Auto Antibodies to Thyroid Peroxidase
37.4C
. Her ECG appears normal, other than a sinus tachycardia, with no signs of ST segment changes. You suspect that her symptoms may be caused by hyperthyroidism, and request blood tests be performed. Her lab values indicate the presence of a positive titer for thyroid-stimulating immunoglobin (TSI). Which sets of results would confirm your diagnosis of Grave’s disease? Auto Antibodies to Thyroid Peroxidase

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