What can you learn from these blood tests?

Ann was a medicines counter assistant at the Update Pharmacy until she retired five years ago. Her husband was recently made redundant, and Ann needed to return to work. There was a vacancy at the Update Pharmacy and now, aged 57, Ann has her old job back.

After a couple of months, pharmacist David Spencer has become concerned about Ann's health and fitness for the job. She seems to be tired all the time and appears to be putting on weight since returning to work. David asks senior counter assistant Hannah what she thinks about Ann's condition.

"During her breaks," says Hannah, "when she's not popping outside for a smoke – she said she's up to 20 a day since Eddie was made redundant – she's dozing off in the staff room a lot of the time."

David has a word with Ann. She confesses to feeling constantly tired and lethargic, and is worried about her health. Ann has her prescriptions dispensed at the pharmacy, so David knows that the only medication she takes is ramipril 10mg daily for hypertension and that it is controlling her blood pressure well.

David suspects Ann may be suffering from a metabolic disorder and persuades her to see her doctor, Lauren Olsen, a trainee GP who David has been helping with prescribing issues.

David contacts Lauren and asks her if his suspicion about Ann's condition has been confirmed.

"I'll send you over the test results and you can see for yourself," says Lauren, "and the script that Ann will be bringing to you will confirm it."

The test results read: ‘U&E – all normal; FBC – all within normal range; FBG – 4.8mmol/l; TSH – 18mU/l; FT4 – 8.9pmol/l; FT3 – 3.5pmol/l.'

Questions

1. What are U&E, FBC, FBG, TSH, FT4 and FT3?

2. What do the test results indicate that Ann is likely to be suffering from?

3. What do the test results indicate that Ann is unlikely to be suffering from?

4. What is on the prescription that David receives for Ann?

5. Which drugs can interfere with TSH, FT4 and FT3 tests?

6. What symptoms indicate the condition that David suspects?

Answer

1. Blood tests. U&E: urea and electrolytes, a measure of kidney function. FBC: full blood count. FBG: fasting blood glucose. TSH: thyroid stimulating hormone. FT4: free thyroxine. FT3: free tri-iodothyronine.

2. Hypothyroidism. The reference range of TSH is 0.4-4.5mU/l; a raised TSH indicates an underactive thyroid gland. The reference range of FT4 is 9-25pmol/l; a low FT4 indicates hypothyroidism, although in early disease it may be at the lower end of normal. The reference range of FT3 is 3.5-7.8pmol/l; a normal or low value, in association with raised TSH and low FT4, indicates hypothyroidism.

3. Diabetes, as FBG is within the normal range of 3.6-6mmol/l.

4. Levothyroxine. 

5. Amiodarone, dopamine, glucocorticoids, lithium, oestrogens, salicylates.

6. Weight gain, dry skin, constipation, cold intolerance, puffy skin, hair
loss, fatigue, menstrual irregularity in women.

Reference

1. Scenario based on a case study in C+D Patient Monitoring in Practice CPD series. 5. Endocrine disorders. September 2007.