- The patient was admitted to the ENT ward for a total thyroid lobectomy procedure. - Pre-operative labs were requested including a CBC, coagulation tests, electrolytes, thyroid function tests, and imaging including a chest x-ray. - Lab results showed the patient's thyroid function tests, CBC, coagulation tests, and electrolytes were mostly within normal ranges except TSH which was slightly elevated at 5.5 nIU/ml. - An ultrasound found thyromegaly with multiple cystic nodules bilaterally and a cytology report found adenomatous colloid with cystic degeneration and hyperplastic changes in an anterior neck mass.

1. Admitting Orders
• Admit patient at ENT ward Tumor
• Secure consent for admission and
management
• Monitor VS every shift and record
• Diet as tolerated
• For Total Thyroid Lobectomy

2. Admitting Orders
• Request For pre-operatively
– CBC w/ platelet count
– ABO typing
– PT, PTT
– Chest X-ray
– Clotting Time and Bleeding Type
– 12 Lead ECG
– FBS, Na, K, Crea

3. Labs
3/9/16
6/20/16
Examination Result Reference Range
FT3 2.2 1.2-4.2 pg/ml
FT4 1.3 0.8-2.0 ng/ml
TSH 5.5 0.4-6.0 nIU/ml
Examination SIR SIRR Conventional Conventional
Reference range
FBS 4.16mmol/l 3.34-
6.12mmol/L
75.6mg/dl 60.7-
111.3mg/dl

4. Labs
Complete Blood Count Results Normal Value
Hemoglobin 153.0 120-150 F ,140-170 M
Hematocrit 0.45 0.37-0.47 F, 0.40-0.50 M
RBC 4.6 4.2-5.4 F , 4.6-8.2
WBC 10.8 5.0-10.0
Differential Count
Segmenters 0.63 0.45-0.65
Lymphocytes 0.32 0.25-0.35
Monocytes 0.02 0.02-0.06
Eosinophils 0.03 0.01-0.06
Basophils 0-0.01
Bleeding Time 2 min 30 secs 2-4 mins
Clotting Time 3 min 30 secs 2-4 mins
Platelet Count 298000 150000-350000

5. Labs
• Ultrasound Report ( 3/11/16)
– Impression thyromegaly, right, multiple cystic
nodules, bilateral, more on the left. No gross
pathology in the scan of the isthmus.

6. Labs
• 6/10/16
Examination Result Reference Range
Protime
Patient 15.5 11-15secs
Control 14.0 12-14secs
% activity 91 70-111
INR 1.11 0.85-1.22
APTT 28.8 23-48
Control 35.8 28.9-41.6

7. Labs
• 4/29/16
– Cytology Report:
• Anterior Neck Mass, Fine needle Aspiration biopsy.
• Adenomatous colloid with cystic degeneration and
hyperplastic changes.
• Chest P-A view
– Old PTB probably inactive, comparison with previous films
recomended

8. Labs
• 6/10/16
Examination Results Reference Range
Sodium 145.0 134-148
Potassium 4.16 3.4-5.3
Creatinine 1.29 0.4-1.40

9. Labs
• 6/20/16
Examinations Reference Range Result
T3 0.52-1.85 1.32
T4 4.80-11.6 8.31
TSH 0.40-5.50 2.38