Conchita´s Laboratory Data

Laboratory Data 1st appointment:

Thyroid function test (TFTs) reports a total T4 test of 22ug/dL, a free T4 test of
7ng/dL and a TSH of 0.01mU/L. The thyroid scan with iodine 131 shows a
homogeneous uptake of 50% in 24 hours.
Laboratory Data 2nd appointment: (Five months later)
The doctor requests a TFTs that reports, total T4 of 3ug/dL, free T4 of 0.2 ng/dL
ans TSH of 42 mU/L. He explains to conchita that the month after she started the
treatment she had to go to a consultation with the doctor for medication
modification to adjust the treatment. Now he indicates orally levothyroxine 150g in
24 hours, he suspends the propanolol and continues the metamizole, citing her for
review again.
Value Normal Conchita´s
Test 1st appointment 2nd appointment

TSH 0.5 – 5,0 mU/L 0.01 mU/L 42 mU/L

Total T4 4- 12ug/dL 22 ug/dL 3 ug/dL
Free T4 (FT4) 0.9- 2.3 ng/dL 7 ng/dL 0.2 ng/dL

 If the TSH level is high and the FT4 result is low this suggests an
underactive thyroid (hypothyroidism) that requires treatment.

 If the TSH level is low and the FT4 result is high this suggests an overactive
thyroid (hyperthyroidism) that requires treatment.

 If the TSH level is slightly raised but the FT4 level is still within the normal
reference range this is called subclinical hypothyroidism or mild thyroid
failure. It may develop into overt or clinical hypothyroidism; an additional
test for thyroid antibodies will help to determine the risk. Some people with
subclinical hypothyroidism, particularly those whose TSH level is greater
than 10 mU/l, may benefit from treatment with levothyroxine.

 A low TSH with a low FT4 may be a result of a failure of the pituitary gland
(secondary hypothyroidism caused by hypopituitarism) or a response
to a significant non-thyroid illness
 Thyroid scan with iodine 131 in 1st Appointement
Value Normal Conchita
24h 8% - 25% 50%

Higher-than-normal uptake may be due to an overactive thyroid gland. The most

common cause is Graves' disease. Other disorders can cause some areas of
higher than normal uptake in the thyroid gland. These include:
 An enlarged thyroid gland with nodules that make too much thyroid hormone
(toxic nodular goiter)
 A simple thyroid nodule that is making too much thyroid hormone
These conditions often cause normal uptake, but it is concentrated in a few (hot)
areas while the rest of the thyroid gland does not absorb any iodine (cold areas).
This can only be determined if the test is done in conjunction with the uptake test.

Lower than normal uptake may be due to:

 Provoked hyperthyroidism (taking thyroid hormone medication or
supplements
 Iodine overload
 Subacute thyroiditis (swelling or inflammation of the thyroid gland)
 Painless (silent) thyroiditis
 Amiodarone (a medicine to treat some types of heart disease)

Based in Conchita´s results we can say that in the laboratory data of her 1st
appointment her total T4 and free T4 is high over normal values and her TSH low
over normal values. We can also see that her results of the thyroid scan with iodine
131 shows us that she presents higher tan normal uptake. These results guides us
to a possible diagnostic of hyperthyroidism based on the TSH and T4 but also a
possible Graves' disease, this based on the thyroide scan with iodine 131.

Because of the treatment the doctor gave Conchita, in her second appointment we
present a new diagnosis, after seeing her new laboratory data we can say that her
total T4 and free T4 decresead but her TSH increased giving us the suspicion that
she might present hypothyroidism