Case 1 involves a 50-year-old woman with symptoms of weight gain, fatigue, memory loss, slow speech, dry skin, constipation, and cold intolerance. On examination, she has a puffy face and thick skin, with a slightly enlarged thyroid gland. Laboratory tests show low T4, high TSH, and normal cholesterol, consistent with hypothyroidism.
Case 2 involves another 50-year-old woman with similar symptoms plus postural dizziness and a deepened voice. Her thyroid gland is not palpable on examination. Laboratory tests again show low T4, elevated but less elevated TSH than Case 1, and high cholesterol, also consistent with hypothyroidism.
it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
it was a case study on hypothyroidism in pediatric patient pharmaceutical care plan ,Diagnostic Technics ,treatment and patient counseling was given to the patient representative.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
2012 Clinical Practice guidelines for hypothyroidism in adults: American Asso...Jibran Mohsin
This is presentation format of 2012 Clinical Practice guidelines for hypothyroidism in adults: American Association of Clinical Endocrinologists (AACE) / American Thyroid Association (ATA)
This presentation contains the hormones related to the thyroid gland. Their Biochemistry, structure, synthesis. How they are measure in modern laboratories and the clinical correlations. It'll come handy for all UG and PG medical students in this domain.
Genomics, Transcriptomics, Proteomics, Metabolomics - Basic concepts for clin...Prasenjit Mitra
This set of slides gives an overview regarding the various omics technologies available and how they can be used for improvement in clinical setting or research
This set of slides deals with the common question that budding researchers or students have regarding how to write in a scientific journal. It briefly showcases the importance of planning and productivity to become better in the writing process.
A presentation on aminoaciduria as inborn errors of metabolism, with emphasis on the screening test ...had some animations which enhanced the presentation...but slideshare does not allow animations... so maybe dull and boring for some...
Slides giving an overview on pH and its measurement.
Contains information about pH meters, its calibration, maintenance , types of ph electrode and modern definition of pH
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. Case 1
• History:
• A 50 year old housewife complains of progressive weight gain
of 20 pounds in 1 year, fatigue, slight memory loss, slow
speech, dry skin, constipation, and cold intolerance.
• Physical examination:
• Vital signs include a temperature 96.8oF, pulse 58/minute and
regular, BP 140/100. She is moderately obese and speaks
slowly and has a puffy face, with pale, cool, dry, and thick
skin. The thyroid gland is slightly enlarged, firm, not nodular,
mobile, and not tender. The deep tendon reflex time is
delayed.
• Laboratory studies:
• CBC and differential WBC are normal. The serum T4
concentration is 3.8 ug/dl (N=4.5-12.5), the serum TSH is 23.0
miU/ml (N=0.2-3.5), and the serum cholesterol is 255 mg/dl.
3. Case 2
• History:
• A 50 year old housewife complains of progressive weight gain
of 20 pounds in 1 year, fatigue, postural dizziness, loss of
memory, slow speech, deepening of her voice, dry skin,
constipation, and cold intolerance.
• Physical examination:
• Vital signs include a temperature 96.8oF, pulse 58/minute and
regular, BP 110/60. She is moderately obese and speaks
slowly and has a puffy face, with pale, cool, dry, and thick
skin. The thyroid gland is not palpable. The deep tendon
reflex time is delayed.
• Laboratory studies:
• CBC and differential WBC are normal. The serum T4
concentration is 3.8 ug/dl (N=4.5-12.5), the serum TSH is 1
miU/ml (N=0.2-3.5), and the serum cholesterol is 255 mg/dl
(N<200).
4. Hypothyroidism
A deficiency in thyroid hormone production or secretion producing a
variety of clinical signs and symptoms of hypometabolism.
Often overlooked may present with serious signs and symptoms.
Treatable with a good prognosis.
Prevalence - undiagnosed hypothyroidism 5%, previously diagnosed
hypothyroidism 3%
Incidence – 226 per 100,000 per year
5. Hypothyroidism
Worldwide, the most common cause of
hypothyroidism is still iodine deficiency.
In developed countries, the most common cause of
primary hypothyroidism is Hashimoto thyroiditis.
Hypothyroidism
• is more common in women than men,
• increases with age
• higher in whites than in blacks or Hispanics
6. Classification
Age of onset
• Congenital
• Acquired
HPT level
• Primary (defect in the thyroid)
• Secondary (defect in the
hypothalamus or pituitary gland, also
called central hypothyroidism)
Severity
• Overt (clinical)
• Mild [subclinical)
Duration
• Permanent
• Transient
7. Primary Hypothyroidism
Thyroid dysgenesis
Destruction of thyroid tissue
Chronic autoimmune thyroiditis: atrophic and goitrous forms
Radiation: 131I therapy for thyrotoxicosis, external radiotherapy to
the head and neck for non-thyroid malignant disease
Subtotal and total thyroidectomy
8. Primary Hypothyroidism
Infiltrative diseases of the thyroid (amyloidosis, sarcoid, lymphoma,
hemochromatosis, scleroderma)
Defective thyroid hormone biosynthesis
Congenital defects in thyroid hormonal biosynthesis
Iodine deficiency
Drugs with antithyroid actions: lithium, iodine and iodine containing
drugs, radiographic contrast agents
9. Central hypothyroidism
Insufficient stimulation by TSH of an
otherwise normal thyroid gland.
Prevalence -
• 1 : 20,000 - 80,000
• 1 in 1000 hypothyroid patients.
• 1 in 160,000 congenital hypothyroidism of
central origin.
10. Central Hypothyroidism
• pituitary macroadenomas, craniopharyngiomas,
meningiomas, gliomas, Rathke cleft cysts,
metastases, carotid aneurysms
Invasive
lesion
• cranial surgery or irradiation, drugsIatrogenic
• head traumas, traumatic deliveryInjury
• postpartum necrosis (Sheehan syndrome),
pituitary apoplexyInfarction
17. Pre-analytical Variables
Age
Pregnancy
TSH/FT4 relationship
Biological differences
Age
• Both TSH and FT4
concentrations are higher in
children, especially in the 1st
week of life and throughout
the 1st year.
• TSH increases with age
• Increased Mean variability
Pregnancy
• ↑ Estrogen levels ↑ 2-3x mean TBG
concentration than pre-pregnancy level by 20
weeks of gestation shift in the TT4 and
TT3 reference range to approximately 1.5
times the nonpregnant level by 16 weeks of
gestation
• ↑ HCG levels cross-react partly with TSH
receptor mildly suppressed levels.
• The peak rise in HCG and nadir in serum TSH
level occurs together at about 10-12 weeks of
gestation.
18. Analytical methods
Gold Standard - Equilibrium dialysis.
• Complex and not widely available.
Commonly used methods - one-step or
two-step immunoassay method.
• Two-step method more reliable than one-step
method.
Chemiluminescence
19. Analytical methods
Analytical interferants - Heterophile
antibodies
• Falsely high or low TFTs.
• Antibodies induced by external antigens
(heterophile antigens) that cross-react with self-
antigens.
• Human anti-mouse antibodies (HAMA) Reacts
with the mouse monoclonal antibodies (used in
many immunometric assays like TSH estimation)
erroneously high or low TSH values
20. Analytical methods
Analytical interferants - Macro-TSH
• Rare condition
• Serum contains antibodies against TSH (anti-TSH
Ig) binds to TSH and neutralizes its activity, but
leaves open epitope to interact with assay
antibodies leading to spuriously high value.
• Detected by:
• Linearity test
• PEG precipitation
• TSH sequestration test
• Gel filtration chromatography
21. Analytical methods
Specimen
• Serum is preferred specimen and ideally whole
blood samples should be allowed to clot for more
than 30 min and then centrifuged and separated.
Storage
• 4-8°C for up to 7 days or −20°C (Long-term).
Collection
• Barrier gel tubes does not affect the results of
TFTs.
22. Analytical methods
Stability
• Quite stable.
• TSH and T4 in dried whole blood spots used to
screen for neonatal hypothyroidism are also
stable for months when stored with a desiccant.
Interferants
• Hemolysis, hyperlipidemia, and
hyperbilirubinemia do not produce interference
in hormone estimation by different assays
23. Measurement of TSH
Immunometric assays with chemiluminescent probes and
solid phase capture Antibodies analytical sensitivity.
Sensitivity is a major issue it is necessary to measure
well below the population reference interval to
differentiate primary hyperthyroidism from other causes
of low serum TSH concentration.
The previously used “generational” concept for TSH
assays is now largely redundant because clinical
guidelines now specify the appropriate sensitivity
required for TSH assays.
24. Measurement of TSH
First-generation assays sensitive enough only to
discriminate normal from hypothyroid subjects
Second-generation assays detect TSH below the
reference interval but not well enough to reliably
discriminate primary hyperthyroidism from other causes
of low TSH.
All assays in clinical practice should be “third generation,”
that is, they should have a coefficient of variation (CV) of
less than 20% (functional sensitivity) at a concentration
of 0.01 mIU/L.
25. Measurement of T3 and T4
Assay Hierarchy
Direct
Equilibrium dialysis
Ultrafiltration
Indirect
Immunoassay
One step
Immunoassay
Two step
Immunoassay
Free Hormone hypothesis
26. Measurement of T3 and T4
fT4
pbT4
Dialysis/Ultrafiltration
Competitive
immunoassay
Mass
Spectrometry
27. Measurement of T3 and T4
Indirect immunoassay methods
• make the assumption that the fT4:tT4 equilibrium is
maintained during immunoassay to an extent sufficient to
return a clinically relevant estimation of fT4.
One-step methods
• incubate the assay antibody and tracer in the presence of all
serum constituents.
Two-step or “back-titration” methods
• allow T4 to equilibrate with the assay antibody in the presence
of all serum components but wash away uncaptured
components before back titrating with tracer.
28. Measurement of T3 and T4
Estimation of total T3 and T4
• Mass spectrometric measurements are now
the method of choice straightforward with
high sensitivity and selectivity.
• Competitive immunoassay
• These methods include a displacing agent
such as 8-anilino-1-napthalene-sulfonic acid to
release thyroid hormone from high-affinity
serum binding sites
31. Inference
• Hypothyroidism is the commonest disorder of thyroid function.
• It is more common in women, and the risk of developing
hypothyroidism increases with age.
• Hypothyroidism is a known risk factor for cardiovascular disease.
• Excluding the newborn period and iodine deficiency, AITD is the
most common cause of primary hypothyroidism.
• Central hypothyroidism (TSH deficiency) is a rare cause of
hypothyroidism.
32. Recent advances
Allen Herndon Dudley syndrome
• Mutation in monocarboxylate transporter-8 gene required
for thyroid hormone transportation into various cells raised
T3, low T4, and normal or elevated TSH
Thyroid receptor-α mutation
• A similar hormonal profile with raised T3, low T4, and normal
TSH Thyroid resistance
Iodotyrosine deiodinase deficiency
• Genetic condition
• have raised T4, normal/low T3, and normal TSH levels.
• Serum and urinary measurement of monoiodothyronine and
diiodothyronine is used to detect
34. Case 1
• History:
• A 50 year old housewife complains of progressive weight gain
of 20 pounds in 1 year, fatigue, slight memory loss, slow
speech, dry skin, constipation, and cold intolerance.
• Physical examination:
• Vital signs include a temperature 96.8oF, pulse 58/minute and
regular, BP 140/100. She is moderately obese and speaks
slowly and has a puffy face, with pale, cool, dry, and thick
skin. The thyroid gland is slightly enlarged, firm, not nodular,
mobile, and not tender. The deep tendon reflex time is
delayed.
• Laboratory studies:
• CBC and differential WBC are normal. The serum T4
concentration is 3.8 ug/dl (N=4.5-12.5), the serum TSH is 23.0
miU/ml (N=0.2-3.5), and the serum cholesterol is 255 mg/dl.
35. Case 2
• History:
• A 50 year old housewife complains of progressive weight gain
of 20 pounds in 1 year, fatigue, postural dizziness, loss of
memory, slow speech, deepening of her voice, dry skin,
constipation, and cold intolerance.
• Physical examination:
• Vital signs include a temperature 96.8oF, pulse 58/minute and
regular, BP 110/60. She is moderately obese and speaks
slowly and has a puffy face, with pale, cool, dry, and thick
skin. The thyroid gland is not palpable. The deep tendon
reflex time is delayed.
• Laboratory studies:
• CBC and differential WBC are normal. The serum T4
concentration is 3.8 ug/dl (N=4.5-12.5), the serum TSH is 1
miU/ml (N=0.2-3.5), and the serum cholesterol is 255 mg/dl
(N<200).
The term myxoedema is used in severe or complicated cases but strictly refers only to the appearance of the skin as it becomes infiltrated with glycosaminoglycans.
Age - both raised and suppressed TSH in elderly have been shown to be associated with increased cardiovascular morbidity
Pregnancy - higher cut-offs for T4, T3 and lower cut-offs for TSH are suggested during pregnancy, which should be standardized in local laboratory
measurement of free thyroid hormone may vary from assay methods. It is advisable to generate normative data for free thyroid hormone in local laboratory with particular assay method
Manufacturers are currently employing various approaches to deal with the HAMA issue with varying degrees of success, including the use of chimeric antibody combinations and blocking agents to neutralize the effects of HAMA on their methods
Manufacturers are currently employing various approaches to deal with the HAMA issue with varying degrees of success, including the use of chimeric antibody combinations and blocking agents to neutralize the effects of HAMA on their methods
It is beholden to the clinical chemist to be aware of and to monitor this aspect of the assay.
It is beholden to the clinical chemist to be aware of and to monitor this aspect of the assay.
specificity of TSH assays is largely of historical concern because modern assays show little cross-reactivity with the other highly homologous pituitary glycoprotein hormones despite sharing a common α-subunit.
whether a wash step is included to remove serum constituents before the addition of the T4 immunoassay tracer. Modern immunoassay methods
are also “analog” because chemically modified T4 probes are used rather than historic radiolabeled hormones.
whether a wash step is included to remove serum constituents before the addition of the T4 immunoassay tracer. Modern immunoassay methods
are also “analog” because chemically modified T4 probes are used rather than historic radiolabeled hormones.
It is beholden to the clinical chemist to be aware of and to monitor this aspect of the assay.
specificity of TSH assays is largely of historical concern because modern assays show little cross-reactivity with the other highly homologous pituitary glycoprotein hormones despite sharing a common α-subunit.
This is less of an issue for tT3 methods owing to the weaker binding of T4 to serum thyroid hormone–binding