[NP-Clinical] 2 lab cases

[Priscilla Merrill]

Pt #1.  Just inherited her.  Very symptomatic, fatigued, logy.  TSH was
about 8 last Fall,  then 5.5 2 mos ago.  These are the results I got.  The
others have only been TSH in past.  She has gone from 25 mcg synthroid
(generic levothyroxine) to 75 mg over 3 6 week increments.  I’m assuming
next step is to increase by 25 mcg again but anything else based ont the
high antibodies?  Thanks to your thyroid gurus out there!

Thanks to Logician home access, I could copy and paste.  Yee Haw!!!
Tests: (1) TSH (30163E)
  TSH                       1.0 uIU/mL                  0.3-5.5          *1

Tests: (2) Free Thyroxine (30247W)
  Free Thyroxine            1.6 ng/dL                   0.8-1.8          *2

Tests: (3) Thyroid Peroxidase Antibodies (80994R)
! Thyroid Peroxidase Antibodies
                       [H]  >1000 IU/mL                 0-34             *3


Pt #2:  DM 2 Thai young man, about 30’s.  Already on ACE, HCTZ, ASA and
Lipitor.  What would you DM gurus recommend with this high microalb.  BP is
well controlled.  ARB????  Not sure why the CK is up.  I think it was
ordered (these were by another provider but she has left) for vague
myalgias.
Lately I’ve had a few well-controlled diabetics on the standard meds with
high microalb ratios and not sure what’s recommended after ACE.
I need to check creatinine’s next time but they have all been fine in the
past.  These are all folks under 50 by the way and we have a large SE Asian
population.
Thanks for advice!!  Priscilla

Tests: (1) Electrolyte Panel (315F)
  Sodium                    139 mmol/L                  135-146          *1
  Potassium                 4.4 mmol/L                  3.5-5.3          *2
  Chloride                  102 mmol/L                  98-110           *3
  CO2                       26 mmol/L                   21-33            *4

Tests: (2) Glycohemoglobin (45484R)
  Hemoglobin A1c       [H]  6.0 %                       0.0-5.9          *5
                             Well-controlled or
                             Non-diabetic: < 6.0%
                             Diabetic hemoglobin A1c:
                              therapeutic goal: < 7%
                              re-evaluate therapy: > 8%
 Calculated Mean Glucose
                            136 mg/dL                                    *6

Tests: (3) Microalbumin (random urine) (6517X)
 Creatinine Random (Urine)
                            227 mg/dL                   20-370           *7
  Microalbumin (urine) [H]  1910 ug/mL                  0-29             *8
 Microalbumin/Creatinine Ratio
                       [H]  841 ug/mg Creatinine        0-29             *9

Tests: (4) BUN (30940E)
  BUN                       10 mg/dL                    7-25             *10

Tests: (5) CK (21576R)
  CK                   [H]  272 IU/L                    0-200            *11


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