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Question: a 67yearold woman is referred for treatment of hyperlipidemia her...

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A 67-year-old woman is referred for treatment of hyperlipidemia. Her cholesterol and triglycerides are high, despite treatment with lipid-lowering medication. She is noted to have hair loss and hoarseness to her voice. She also complains of cold intolerance and fatigue. The physician orders a BMP, lipid panel, and thyroid testing cascade. Results are as follows:

Analyte 2/19/2018 09:50 . Reference Range

Na 141 . 135-145 mEq/L

K 4.1 . 3.5-5.0 mEq/L

Cl 101 . 95-105 mEq/L

CO2 25 . 22-28 mEq/L

Glucose 103 . 70-100 mg/dL

BUN 8 . 7-20 mg/dL

Creat 0.4 . 0.5-1.1 mg/dL

BUN/Creat Ratio 20 . 10-20

Total Cholesterol 250 . 150-200 mg/dL

LDL 147 . <100 mg/dL

HDL 41 . 40-80 mg/dL

Triglycerides 310 . <150 mg/dL

TSH 43 . 0.4-4.5 mIU/L

fT4 0.4 . 0.8-2.4 ng/dL

tT3 Not Indicated . 80-180 ng/dL

(1) Highlight the abnormal results in the above table. (1 pt)

(2) Based upon the above clinical and laboratory data, does this patient have hypothyroidism or hyperthyroidism? Is this a primary, secondary, or tertiary thyroid disorder? (3 pts)

(3) The physician suspects an autoimmune etiology. Name the most likely condition and a lab test the can help confirm this potential diagnosis. (2 pts)

(4) Explain why this patient has abnormal glucose, lipid panel, and creatinine results? (4 pts)

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