A 23-year-old college student goes to her doctor complaining of headache, fatigue, weight gain and a nagging cough. She is normally very active, competing in volleyball, soccer and rugby. She's achy and always feels like she has a chill. She says she has been trying to lose the weight by exercising more and eating lots less, but it doesn't seems to be helping. All that is happening is she can hardly drag herself out of bed. And her hands and joints are swollen. After checking for joint damage (there is none) her doctor sends her along to an endocrinologist who orders a series of tests and gets the following results.
She has elevated TSH (15 mcg/ml), low free t4 (0.05 ng/dl), elevated calcitonin (18 pg/ml) and elevated growth hormone (8 ng/dl).
They did a fasting OGTT but that seems normal (though if anyone can point us to a site that lists ranges of a 30-minute serum level, we'd probably be willing to deify you).
We're wavering on this one. We're leaning toward hypothyroidism, but not sure if it's Hashimoto or not, and if it is, how the growth hormone and calcitonin fit into the picture. We've been at it for about 2 hours today and are going to take a break for now. But have fun with it. It's due the 25th and I expect to get grades within a week after.
Trust me, I'd much prefer one (though she requires two), but some of the labs she listed were so weird and esoteric that it literally took me like five or six different sites to find them all. As soon as cardio goes up, I'm starting my labs research, that's for darn skippy.
Cool. Can you post your next case in this thread, too, so I'll get an email notification when it's up? If you've already posted in another thread, that's fine. I sometimes don't have much time to cruise the postings on AN and I didn't want to miss the next medical puzzle installation! :)
AtomicWoman
1,747 Posts
cmonkey, have you checked:
http://referencelab.clevelandclinic.org/DBSearch/Search.htm
They have every freaking lab test I have ever seen! All you have to do is click on the test name and it comes up with the reference ranges.
You might, in future write-ups, just stick with one lab's reference ranges (like this one), which is what most doctors do anyway.
Anyway, keep us posted!