RECENT Artery Conversations
I was approached this week by one of our endocrinologists with a case he had questions about, and I'd like to hear the thoughts from you all. Back in November, this 11 year old female presented with unexpected weight loss and neck swelling. Labs done by her PCP showed suppressed TSH and fT4 >7.7 and an elevated a-TPO. Labs done here are shown below (note the very positive TSI!) So, the patient was started on methimazole (20 mgs q am and 10 mgs qpm). Follow-up labs were done on 1/15/19 and 2/4/19 at outside labs (I don't know their methodology). It is reassuring that the fT4 has dropped, though perhaps now too much, and T3 is normal. But the doctor is questioning the very low TSH. I'm thinking the TSH is just lagging to catch up, as shown in this figure from the NACB thyroid guidelines (I think she's in the highlighted area still) Are there any other considerations for this time? Or should we just continue to wait and monitor?
Clinical laboratories play a critical role in detecting when novel drugs of abuse emerge, but how well are they equipped to to do so? What are some of the major challenges in implementing time-of-flight mass spectrometry for routine drugs of abuse testing? This month’s Artery Article Club challenges you to answer these and other questions after reading the selected article. Discuss the article online.
January was a month of resettling and thinking about quality control (QC) and instrumentation. Our members discussed the effects of humidity on instrument performance, the need for a QC mean value for each instrument and comparisons between old and new instruments. Read the summary.