Hashimoto thyroiditis (chronic autoimmune thyroiditis) is the most common cause of hypothyroidism in iodine-sufficient areas of the world. This condition, however, can sometimes show hyperthyroidism. A 39-year-old femalewas admitted to hospital due to shortness of breath and tremor four hours before hospitalization. There were nausea, chestpain, cold chills, and palpitation. She was diagnosed with Hashimoto's thyroiditis and routinely received tyrosol,propranolol, and dexamethasone. Physical examination showed cervical mass, afebrile, blood pressure of 130/70 mmHg,pulse rate of 110 beats/minute and respiratory rate of 20 breaths/minute. Laboratory examinations showed WBC 7.53 x 109/L, Hb 11.0 g/dL and platelet count of 168 x 109/L. Chest X-Ray: negative for infiltrates. Several laboratory testswere performed, abnormal results were as follows: FT4 level of 2.96 ng/dL (increased), TSH level of 0.003 µIU/mL(decreased), anti-TPO (antithyroid microsomal antibody) level of 306 IU/ml (increased), and IgE level of 213.6 IU/mL(increased). Peripheral blood smear, coagulation test, serum electrolytes, liver function tests, renal function tests, urinalysis,CEA and Ca 125 were within normal limits. Thyroid ultrasound was performed and showed a benign lesion. Fine needleaspiration biopsy showed lymphocytic Hashimoto's thyroiditis. Echocardiography showed hyperthyroid heart disease. Dueto an increase of anti-TPO and FT4 levels, a decrease of TSH levels and lymphocytic thyroiditis from FNAB, this patient wasdiagnosed with a hyperthyroid phase of Hashimoto's thyroiditis. Thyroid function tests and thyroid antibody tests must bemonitored to distinguish between the hyperthyroid and hypothyroid phase of Hashimoto thyroiditis.
Background: Testicular cancer is now the most common malignancy in young males. Markers available in the management of patients with testicular cancer are alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and lactate dehydrogenase (LDH). Female patients with androgen insensitivity syndrome (AIS) and pure gonadal dysgenesis have a pure XY karyotype and an increased risk of developing a gonadal malignancy.Case Description: A 26-year-old female presented with a hardened stomach and primary amenorrhoea. Physical examination revealed Tanner Stage I for both the right and left breast and no pubic or axillary hair. On local examination, there was a large firm non-tender mass extending across the abdominopelvic region. Gynecological examinations revealed normal labia; however there was clitoromegaly, the vagina was blind (5 cm) with the absent cervix. Laboratory tests with increased abnormal results were as follows: LDH 3,448 U/L, AFP 1,842.6 ng/mL, Cortisol 22.41 ug/dL and Testosterone 128.7 ng/dL. An MSCT of the abdomen showed a solid mass with no signs of a vagina or uterus. Blood karyotyping results were 46 XY with the presence of the SRY gene. Due to an increase in LDH, AFP, Cortisol and Testosterone, with 46 XY karyotyping, Tanner stage 1 breasts, pubic and axillary hair, female genitalia phenotype and abdominal MSCT showing a solid mass with no signs of vagina and uterus, this patient was diagnosed with non seminoma testicular cancer with widespread disease and 46, XY karyotype (male).Conclusion: Testicular cancer is common in patients with gonadal dysgenesis, due to an increase in malignancy risk.
Preliminary: Hashimoto thyroiditis (chronic autoimmune thyroiditis) is the most common cause of hypothyroidism in iodine- sufficient areas of the world, but can sometimes show hyperthyroidism. Case: A 39-year-old female was referred due to shortness of breath and tremor, four hours before hospitalization. There was nausea, chest pain, cold chills and palpitation. She was diagnosed with Hashimoto’s thyroiditis and routinely received tyrosol, propanolol and dexamethasone. Physical examination: cervical mass, afebrile, blood pressure 130/70 mmHg, pulse rate 110 x/minute and respiratory rate 20 x /minute. Laboratory examinations showed WBC 7.53 x 109/L, Hb 11.0 g/dL and platelet count 168 x 109/L. Chest X-Ray: negative for infiltrates. Several laboratory tests were performed, abnormal results were as follows: FT4 2.96 ng/dL (increased), TSH 0.003 uIU/mL (decreased), anti-TPO (antithyroid microsomal antibody) 306 IU/ml (increased), Ig E 213.6 IU/mL (increased). Peripheral blood smear, coagulation test, serum electrolytes, liver function tests, renal function tests, urinalysis, CEA and Ca 125 were within normal limits. A thyroid ultrasound resulted in a benign lesion. Fine Needle Aspiration Biopsy concluded in lymphocytic Hashimoto’s thyroiditis. Echocardiography showed hyperthyroid heart disease. Discussion: Due to an increase in anti-TPO and FT4, a decrease in TSH and lymphocytic thyroiditis from FNAB, this patient was diagnosed with Hashimoto’s Thyroiditis Hyperthyroid Stage. Conclusion: Thyroid function tests and thyroid antibody tests must be monitored to decide whether it is hyperthyroid or hypothyroid stage of Hashimoto thyroiditis.
Kidney disease is a global public health problem, affecting over 750 million people worldwide. Glomerular Filtration Rate(GFR), which is calculated by measuring the creatinine clearance with 24-hour urine collection (CC) can be inaccurate due toimproper urine collection, causing the need for an easier and accurate method of calculation. This study was anobservational analytical cross-sectional research using consecutive retrospective sampling. Samples were data of patientswith Chronic Kidney Disease (CKD) who underwent CC test at the Clinical Pathology Laboratory of the Dr. Soetomo HospitalSurabaya during September-October 2018. Data were compared with the results of Cockcroft-Gault (CG), MDRD, andCKD-Epi formula, and were analyzed using the one-sample Kolmogorov-Smirnov test, paired T-test, and Wilcoxon SignedRank test. Correlation of CC results with CG, MDRD, and CKD-Epi results was tested with Spearman's rho and Bland Altmantest. The difference test of CC with CG, MDRD, and CKD-Epi showed results of (p=0.000), (p=0.194), and (p=0.468),respectively. There were significant differences between CC compared to CG, but not MDRD and CKD-Epi. There was amoderate correlation between CG, MDRD, CKD-Epi, and CC with r=0.529; 0.448, and 0.463, respectively. The mostcompatible formula was CKD-Epi. The measurement of GFR with CC correlated with CG, MDRD, and CKD-Epi; therefore, theycould be used as an alternative method to calculate GFR. Further experiments using an exogenous marker should beperformed to determine a suitable eGFR formula according to the degree of damage to the kidney.
Iron plays a role in multiple physiological functions, naming oxygen transport, gene regulation, DNA synthesis, DNA repair, and brain function. Iron deficiency anemia (IDA) may happen following iron deficiency, but iron deficiency alone may cause negative impacts on the health risk of pediatric patients. The degree of iron deficiency is described by total body iron (measured by ferritin), transport iron (measured by transferrin saturation), serum iron, and other hematologic and biochemical markers. Iron deficiency anemia is a result of insufficient iron supply causing the inability to maintain normal levels of hemoglobin. The most common causes of microcytic anemia in children are iron deficiency and thalassemia minor. There are various hematologic and biochemical parameters used for screening and diagnosis of iron deficiency anemia in children, but there is no single “best” test to diagnose iron deficiency with or without anemia. The “gold standard” for identifying iron deficiency is a direct test-bone marrow biopsy with Prussian blue staining. This article aims to explain iron metabolism in children and discuss the role of hematologic and biochemical parameters for screening and diagnosis of iron deficiency anemia in children.
Thrombocyte concentrate (TC) transfusion plays an important role in preventing bleeding in patients with severe thrombocytopenia. Febrile non hemolytic transfusion reaction (FNHTR) may occur after TC administration. IL-1ß and TNF-α cytokines released by thrombocytes and leucocytes during TC storage play important roles in the occurrence of FNHTR after TC transfusion. The purpose of this study was to analyze changes in levels of IL-1ß and TNF-α on the duration of TC storage. This was an observational analytical research with time series design carried out at the Clinical Pathology Laboratory and Blood Bank of the Dr. Soetomo Hospital Surabaya in September - October 2019. IL-1ß and TNF -α levels in 20 bags of Thrombocyte Concentrate blood components derived from Platelet Rich Plasma during storage for day 1, day 3 and day 5 were measured using ELISA Sandwich method. The statistical analysis was performed using the Subject Same Variant Test or Friedman Test. The results showed no significant differences in the levels of IL-1ß and TNF-α based on the storage duration of TCs on day 1, 3 and 5, p = 0.262 and p = 0.534 respectively. There was a significant difference of IL-1ß levels between day 1 and day 3 (p=0.032).
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