Discussion board post, 1-2 pages with references on the same page is fine, Choose one to write about, which ever is least complicated! I\’ll paste it below. I\’ll attach it with the grading rubric too.
Thanks, Rob If it costs more hit me up!

For this discussion board, you may choose any one of the following assignments:

Choose 3 different types of anemia. Compare and contrast them using using lab data criteria (describe the lab data which would be indicative of each type of anemia). Describe any clinical features and symptoms of each. You may create a chart and/or graphics. Briefly describe how each type may be treated.
Choose at least 3 white blood cell indices (basophils, neutrophils, monocytes, granulocytes, etc). Describe the normal values for each and what abnormal values for each may indicate ( you can create a flowchart which may may make your answer more organized). Also, answer the following: how would you follow-up on abnormalities of the WBC indices?
Conduct a review of the LFTs ( you may use a flowchart or graphics). Describe each component of the LFT (AST, ALT, alk phos, etc). Discuss what may cause the LFTs to be abnormal. Discuss any patient history questions that may be important when interviewing a patient (assume, for this assignment, that you are working a patient over the age of 18). Describe what an initial work-up for LFTs may include.
Conduct a review of thyroid function tests (TFTs; TSH and Free T4). Discuss the pathophysiology of thyroid hormone production. What are the differential diagnoses for an adult patient with abnormal thyroid function tests? What questions may be important to include in the initial history for a patient whose TFTs are abnormal? What may the initial work-up include for a patient with abnormal TFTs.
**You can generalize when talking about the patient history and the work-up as this can be difficult since you don\’t have a specific patient history to review. Assume the labs you are reviewing are for adult patients.

Discussion: Thyroid Function Tests

Thyroid function tests (TFTs) are usually conducted to determine the levels of thyroid hormones and establish whether a patient has thyroid disorders. Thyroid disorders usually cause an imbalance in the blood levels of thyroid hormones (Soh & Aw, 2019). The hypothalamic-pituitary-thyroid axis is a self-regulatory axis that controls the concentrations of thyroid hormones in the blood. Therefore, abnormal levels of these hormones may also be a sign of hypothalamus and pituitary gland disorders (Ohba, 2021). The purpose of this discussion is to review TFTs particularly Thyroid Stimulating Hormone (TSH) and Free Thyroxine (FT4). It will also include a description of the pathophysiology of thyroid hormone production, the differential diagnoses for an adult patient with abnormal thyroid function tests, possible questions that may be important to include in the initial history for a patient whose TFTs are abnormal, and the initial work up to include for a patient with abnormal TFTs.

Thyroid Function Tests

The healthcare provider can conduct several TFTs during the physical examination to establish whether there are any variations between the recorded values and normal ranges. The current discussion will specifically focus on TSH and Free T4 tests. Produced by the pituitary gland, the role of TSH is to create a balance in the blood concentrations of thyroxine (T4) and triiodothyronine (T3). In most cases, hypothyroidism or thyroid hormone deficiency causes an elevation of TSH levels in the blood. On the other hand, excess production of thyroid hormone or hyperthyroidism is usually linked with low TSH levels in the blood. Normal blood levels of TSH in adults range between 0.40 and 4.50 mlU/mL milli-international units per liter of blood (Cleveland Clinic, 2022). FT4 test is the laboratory analysis conducted to measures the blood levels of T4 that serves the role of eliminating the impact of proteins that bind naturally to T4. Normal blood levels of FT4 in adults usually range between 0.9 and 1.7 ng/dL (Cleveland Clinic, 2022). It is important to evaluate TSH and FT4 levels together when testing thyroid function. Low TSH with high FT4 signifies hyperthyroidism whereas high TSH and low FT4 is a sign of hypothyroidism. However, low FT4 and low TSH shows low thyroid function due to an abnormality in either the hypothalamus or the pituitary gland (Shahid et al., 2021). Nurses should know how to interpret TFTs in order to detect thyroid problems early enough for timely intervention.

The Pathophysiology of Thyroid Hormone Production

The production and regulation of thyroid hormone occurs in the hypothalamic-pituitary-thyroid axis involving the hypothalamus, the pituitary gland, and the thyroid gland. The process starts in the hypothalamus with the secretion of the thyrotropin-releasing hormone (TRH) (Shahid et al., 2021). TRH is released into the anterior pituitary gland where it stimulates the production of TSH. TSH binds with THS receptors in the blood leading to their activation. The activation of TSH receptors triggers the activation of adenylyl cyclase and intracellular levels of cAMP which eventually triggers a five-step process leading to the production and storage of T3 and T4 (Shahid et al., 2021). The five steps include thyroglobulin synthesis, the uptake of iodide, thyroglobulin iodination, formation of T3 and T4, and storage of thyroid hormones in the follicular lumen (Shahid et al., 2021). The stored thyroid hormones are released into the blood as necessary depending on bodily needs.

The Differential Diagnoses for an Adult Patient with Abnormal Thyroid Function Tests

Several diseases might be suspected in an adult patient with abnormal thyroid function test (Kravets, 2016). The following are the differential diagnoses for an adult patient with abnormal thyroid function tests;

• Hyperthyroidism
• Hypothyroidism
• Thyroiditis
• Hashimoto’s disease
• Goiter
• Graves’ disease
• Thyroid tumor
• Thyroid cancer
• Thyroid nodule

Questions That May Be Important To Include In The Initial History For A Patient Whose TFTs Are Abnormal

Asking a patient relevant questions during history taking enables the clinician to generate subjective data that can be helpful in making an accurate diagnosis. For instance, it is important for the healthcare provider to understand the symptoms that a patient might be experiencing. Thyroid disorders usually cause clinical manifestations that can help the healthcare provider to predict possible conditions that a patient might be suffering from (Kravets, 2016). Additionally, abnormal TFTs can occur as a result of medical conditions not related to the thyroid gland as well as due to medication use. The following are some of the questions that a clinician can ask an adult patient with abnormal TFTs results;

• Do you have any problematic symptoms? If yes, which ones are they, and for how long have you been experiencing them?
• What other diseases are you currently suffering from and which ones have you recovered from?
• Have you undergone surgery before? If yes, which one was it and when did it happen?
• Are you taking any medications? If yes, for how long have you been using them?
• What is your typical diet?

The Initial Workup to Include for a Patient with Abnormal TFTs

It is important to conduct diagnostic tests in order to determine the actual condition that a patient might be suffering from. Numerous evidence-based diagnostic procedures can aid the diagnosis process (Kravets, 2016). The initial workup for a patient with abnormal TFTs may include the following procedures;

• Obtaining the patient’s history by asking relevant questions
• Perform TFTs
• Scanning of the thyroid gland
• Obtain radioactive iodine uptake
• Conduct thyroid antibody tests for thyroid peroxidase antibodies (TPO) antibodies, thyroglobulin (TG) antibodies, and thyroid receptor antibodies including thyroid-stimulating immunoglobulins (TSI) and thyroid blocking immunoglobulins (TBI)
• Perform calcitonin test
• Perform thyroglobulin test

References

Cleveland Clinic. (2022). Thyroid blood tests. https://my.clevelandclinic.org/health/diagnostics/17556-thyroid-blood-tests#:~:text=Normal%20test%20range%20for%20an,T4%20levels%20may%20indicate%20hyperthyroidism.

Kravets, I. (2016). Hyperthyroidism: Diagnosis and treatment. American Family Physician, 93(5), 363-370. https://www.aafp.org/afp/2016/0301/p363.html

Ohba K. (2021). An update on the pathophysiology and diagnosis of inappropriate secretion of thyroid-stimulating hormone. International Journal of Molecular Sciences, 22(12), 6611. https://doi.org/10.3390/ijms22126611

Shahid, M. A., Ashraf, M. A., & Sharma, S. (2021). Physiology, thyroid Hormone. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK500006/

Soh, S. B., & Aw, T. C. (2019). Laboratory testing in thyroid conditions – pitfalls and clinical utility. Annals of Laboratory Medicine, 39(1), 3–14. https://doi.org/10.3343/alm.2019.39.1.3