Would you expect this patient’s TSH, T3 and T4 to be high or low?

Please respond to the 2 following posts with separate reference lists.
1. Week 6: Case Study and Discussion
The clotting mechanism and the eventual hemostasis it precipitates is essential to life, and disruptions in the system can create serious problems up to and including death. Being a complex system that requires many proteins and cofactors there are several ways the coagulation system can malfunction. Coagulations happens through what is called a clotting cascade, one reaction or interaction create products that cascade into the next. The cascade can be kicked off or started by exposure to certain chemicals or molecules as well as perceived damage to tissue (Dlugasch & Story, 2021). In DIC various clotting proteins and factors are inappropriately triggered creating many micro clots, these micro clots consume all the clotting factors in circulation creating a scarcity of necessary materials to create new clots, putting the patient in a state where they are likely to bleed, sometimes referred to as a consumptive coagulopathy.
PT and aPTT tests each examine a different piece of the clotting cascade. Either one being prolonged indicates some dysfunction in the clotting system. Dlugasch and Story briefly summarize each test, examining that the aPTT test examines the intrinsic pathway to the clotting cascade, while PT observes the extrinsic pathway (Dlugasch & Story, 2021). Each test can be used to monitor drug efficacy depending on where the drug in question effects the clotting cascade.
Fibrin degradation products like D-dimer become elevated in DIC (Levi, 2018). As the coagulation system malfunctions, and micro clots are formed throughout the body, plasminogen goes to work and tries to break down these clots. As the fibrin in these clots is broken down, fibrin degradation products like D-dimer elevate.
According to Levi several pathologies that can be the underlying cause to DIC exist including sepsis, cancer, trauma, obstetrical complication, vascular abnormalities, immune reactions, and heat stroke (Levi, 2018).
Dlugasch, L., & Story, L. (2021). Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.
Levi, M. (2018). Pathogenesis and diagnosis of disseminated intravascular coagulation. International Journal of Laboratory Hematology, 40, 15–20. https://doi.org/10.1111/ijlh.12830
2. A 35-year-old female presents to the clinic with bulging eyes, hand tremors and unexplained weight loss. The final diagnosis is Grave’s Disease.
1. Compare and contrast Grave’s Disease and Hashimoto’s Disease.
2. Would you expect this patient’s TSH, T3 and T4 to be high or low? Explain your reasoning.
3. Discuss the significance of Hürthle cells in thyroid disease.
Grave’s Disease and Hashimoto’s disease are immune disorders, in which the body mistakes its own cells as pathogens and attacks its own cells. Both conditions produce auto-antibodies that attack the thyroid, an organ that regulates the body’s metabolism, among other things. In Grave’s disease, the antibodies overstimulate the TSH receptor, increasing the production of T4. The thyroid is enlarged, which is called a goiter, the eyes will bulge, and there is an increase in appetite. In contrast, Hashimotos is a hypothyroid disease, since the auto-antibodies attack the thyroid and cause chronic inflammation. It mostly affects women and causes fatigue, muscle aches, increased sensitivity to cold, weight gain and heavy periods (Bishay et al., 2016).
The patient would have an increase in T4 and T3 and lowered TSH levels in Grave’s disease. TSH stimulates the production of T4 and T3. The T3 and T4 would then inhibit the production of TSH normally. In Grave’s, the TSH hormone is stimulated by antibodies, so production of T3 and T4 is increased significantly and inhibits the TSH more than usual (Bishay et al., 2016).
Hurthle cells are found in thyroids and may be benign or malignant tumors. This makes it challenging to use Hurthle cells in a diagnosis. Hurthle cells are easily identifiable in that they are significantly larger than follicular cells found in the thyroid. They are more commonly found in individuals who have had Grave’s disease for long periods of time, or patients with Grave’s disease who have undergone radioactive iodine ablation. They also are more common in older adults (Cannon, 2011).
Bishay, R. H., and R. C. Y. Chen. “Hashimoto’s Thyroiditis and Graves’ Disease in One Patient: The Extremes of Thyroid Dysfunction Associated with Interferon Treatment.” Case Reports in Endocrinology, Hindawi, 2 Mar. 2016, https://www.hindawi.com/journals/crie/2016/6029415/.
Cannon, Jennifer. “The Significance of Hurthle Cells in Thyroid Disease.” The Oncologist, AlphaMed Press, 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228061/.

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