Diagnostic Tests for Hypothyroidism
Hypothyroidism Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Hypothyroidism:
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- Adrenal Gland Health: Home Testing:
- Breast Cancer: Related Home Tests:
Hypothyroidism Diagnosis: Book Excerpts
Diagnosis of Hypothyroidism: medical news summaries:
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Diagnostic Tests for Hypothyroidism: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Hypothyroidism.
THYROID ENLARGEMENT:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
Routine tests include a CBC, sedimentation rate, urinalysis, thyroid profile with a TSH immunoassay, chemistry panel, chest x-ray, and EKG. Thyroid antibodies may be tested if Hashimoto's thyroiditis is suspected.
The most important study is a thyroid technetium-99m or iodine-123 uptake and scan. If the results of these are abnormal, then an endocrinologist or general surgeon should be consulted to assist in the interpretation. If the scan indicates a cold nodule, ultrasonography may be done to determine whether the nodule is cystic or solid. If it is cystic, generally it can be aspirated and followed. If it is solid, a biopsy or aspiration and biopsy should be undertaken. If there are malignant cells or at least suspicious cells for malignancy, surgery should be done. If the scan reveals a hot nodule and there is clinical and laboratory evidence of thyrotoxicosis, the patient should be treated with radioactive iodine or surgery. If the scan shows diffuse uptake of radioactive materials and there is clinical thyrotoxicosis, the patient also may be treated with radioactive iodine or surgery.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
ACIDOSIS (DECREASED PH):
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
This should include a CBC, chemistry panel, electrolytes, arterial blood gas analysis, serum and urine ketones, lactic acid, pulmonary function tests, EKG, and consultation with a pulmonologist or nephrologist.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Thyroid enlargement:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
The patient’s history commonly reveals the cause of thyroid enlargement. Important data includes a family history of thyroid disease, onset of thyroid enlargement, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Begin the physical examination by inspecting the patient’s trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. To palpate the thyroid gland, you’ll need to stand behind the patient. Give the patient a cup of water, and have him extend his neck slightly. Place the fingers of both hands on the patient’s neck, just below the cricoid cartilage and just lateral to the trachea. Tell the patient to take a sip of water and swallow. The thyroid gland should rise as he swallows. Use your fingers to palpate laterally and downward to feel the whole thyroid gland. Palpate over the midline to feel the isthmus of the thyroid.
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is often continuous.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Thyroid enlargement:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
The patient’s history commonly reveals the cause of thyroid enlargement. Important data include a family history of thyroid disease, when the thyroid enlargement began, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Begin the physical examination by inspecting the patient’s trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. To palpate the thyroid gland, you’ll need to stand behind the patient. Give the patient a cup of water, and have him extend his neck slightly. Place the fingers of both hands on the patient’s neck, just below the cricoid cartilage and just lateral to the trachea. Tell the patient to take a sip of water and swallow. The thyroid gland should rise as he swallows. Use your fingers to palpate laterally and downward to feel the whole thyroid gland. Palpate over the midline to feel the isthmus of the thyroid.
During palpation, be sure to note the size, shape, and consistency of the gland as well as the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit, which is commonly continuous.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hypothyroidism:
Physical examination (PE)
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The features frequently found in hypothyroidism should be sought.
A. Observation. A welcoming handshake may reveal cold skin and further observations uncover altered affect, hoarseness, facial or eyelid edema, hair loss (scalp, eyebrows), and physical or mental slowing.
B. General examination. Vital sign abnormalities commonly include weight gain, diastolic hypertension, and bradycardia. All major organ systems are affected by thyroid hormone deficiency. The heart may be enlarged, because of both dilation and pericardial effusion, which is indicated by a cardiac rub or distant heart sounds. Adynamic ileus, rarely, can result in megacolon or intestinal obstruction. Tissue glycosaminoglycan accumulation and reduced lymphatic clearance of interstitial proteins can produce carpal tunnel syndrome. The relaxation phase of deep tendon reflexes is prolonged, creating the characteristic “hung-up reflex.” Orthostatic hypotension suggests secondary or tertiary disease, as do visual field defects and galactorrhea.
C. Thyroid examination. Inspect the neck below the thyroid cartilage from the front and side. During palpation, approach the patient from the front or from behind and palpate using the fingers or thumbs. Having the patient swallow during both inspection and palpation causes the thyroid to move and aids in developing a three-dimensional impression of the gland. The size, consistency, and tenderness of the gland should be noted, as should the presence and characteristics of any nodules.
Testing
A. Laboratory tests. The most useful test is a sTSH, which is elevated (>10 µU/ml) in the vast majority of patients with hypothyroidism (1). Primary hypothyroidism is confirmed by a low free thyroxine index (FTI) or free T4 (fT4) measured directly (5). Antithyroid antibodies are not usually necessary in the evaluation of patients with hypothyroidism.
B. Diagnostic imaging. Radionuclide scans are not commonly helpful in the evaluation of patients with hypothyroidism. Radioactive iodine uptake is typically low in hypothyroidism of any cause. Notable exceptions are the rare cases of iodine deficiency or an intrathyroidal block in thyroid hormone production or release. The underlying pathology determines the distribution of the isotope in the gland.
Diagnostic assessment
A. Pitfalls of sTSH. The sTSH is characteristically elevated in primary hypothyroidism. Starvation, corticosteroid administration, and use of dopamine can lower sTSH, even in hypothyroid patients, making the diagnosis more difficult. In patients with severe nonthyroidal illness, low peripheral thyroid hormone levels may suggest hypothyroidism. However, the sTSH is usually normal unless affected by starvation or therapies.
B. Primary hypothyroidism. Most patients have primary disease. Typical findings on history and PE, coupled with an elevated sTSH and low FTI or fT4, are sufficient for the diagnosis. Hypothyroid patients should be treated with T4, and replacement therapy monitored using sTSH (5). Retest annually or at least 6 to 8 weeks after changes in therapy.
C. Secondary or tertiary hypothyroidism. In a patient with overt hypothyroidism, a sTSH that is low, normal, or only mildly elevated suggests secondary or tertiary hypothyroidism. The historical and clinical features previously discussed support the diagnosis, and evaluation of the pituitary is necessary (4). Multiple endocrine end-organ failure caused by the autoimmune destruction of endocrine glands (Schmidt’s syndrome) is a special case of primary hypothyroidism that mimics secondary level disease.
D. Severity. Most patients will have only mild or moderate disease at the time of diagnosis. Profound hypothyroidism with hypothermia and stupor (myxedema coma) is life threatening and requires hospitalization. Factors that predispose to myxedema coma include infection, trauma, cold exposure, and central nervous system depressants.
E. Subclinical hypothyroidism. In patients with subclinical hypothyroidism not treated with thyroid hormone replacement, monitor clinical and biochemical markers for evidence of progressive thyroid dysfunction. An appropriate follow-up interval has not been firmly established, but every 2 to 5 years may be adequate (1).
References
1. Helfand M, Redfern CC. Screening for thyroid disease. Ann Intern Med 1998;129:
144–158.
2. White GH, Walmsley RN. Can the clinical assessment of thyroid function be improved? Lancet 1978;2(8096):933–935.
3. Thyroid Guidelines Task Force of the American Association of Clinical Endocrinologists and the American College of Endocrinology. ACCE Clinical Practice Guidelines for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism. Endocrine Prac 1995;1:54–62.
4. Vance ML. Medical progress: hypopituitarism. N Engl J Med 1994;330:1651–1662.
5. Lindsay RS, Toft AD. Hypothyroidism. Lancet 1997;349:413–417.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Thyroid Enlargement/Goiter:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
A. General examination. Look for typical vital and physical signs consistent with hypothyroidism or thyrotoxicosis. Pemberton’s sign can be induced by having the patient raise both arms above the head.
B. Thyroid examination. Inspect the neck below the thyroid cartilage from the front, using cross-lighting to accentuate shadows and masses. Full extension of the neck enhances visibility of the gland. Inspection from the side with measurement of any prominence of the normally smooth and straight contour between the cricoid cartilage and the suprasternal notch is useful. Palpitation is done using the technique with which the examiner is most experienced and skilled. Approach the patient from either the front or behind and palpate using the fingers or thumbs. If felt between the cricoid cartilage and the suprasternal notch, the thyroid isthmus can be used to help locate the gland. Palpation of the lobes can be improved by relaxation of the sternocleidomastoid; for example, the left lobe can be defined better by having the patient slightly flex and rotate the neck to the left. Other useful maneuvers include measuring the circumference of the neck or the dimensions of each lobe. Note the location, size, consistency, mobility, and tenderness of any nodules. Having the patient swallow during both inspection and palpation causes the thyroid to move and aids in developing a three-dimensional impression of gland shape and size. This maneuver can also make a low-placed gland accessible. Categorize thyroid size as “normal” or “goiter,” and subcategorize “goiter” as “small” (two or less times normal) or “large” (more than two times normal) (2).
Testing
A. Laboratory testing. The sensitive TSH (sTSH) assay is the single best test to evaluate thyroid status. Elevated sTSH is highly suggestive of hypothyroidism (Chapter 14.4). If sTSH is suppressed, an elevated free thyroxine index (FTI) or free thyroxine (fT4) measured directly, confirms thyrotoxicosis (Chapter 14.8). In a patient with a suppressed sTSH and a normal FTI or fT4, serum triiodothyronine (T3) should be measured to assess for possible T3 thyrotoxicosis.
B. Diagnostic imaging. Nuclear scans and ultrasound studies are not warranted in the routine evaluation of simple or multinodular goiter (4). Ultrasonography may be helpful in patients with equivocal findings on palpation. Symptoms suggestive of substernal mechanical pressure require evaluation, usually by computed tomography (CT) or magnetic resonance imaging (MRI).
C. Other tests. Fine needle aspiration biopsy (FNAB) should be performed in cases of a solitary or dominant nodule found by palpation. Pulmonary function tests are warranted with evidence of inspiratory impairment. Barium swallow is indicated to evaluate goiter-associated dysphagia.
Diagnostic assessment
The evaluation of goiter focuses on the history, thyroid palpation, and functional status of the gland. An asymptomatic patient with a simple or multinodular goiter associated with a normal metabolic state does not necessarily require further diagnostic studies or treatment. Periodic assessment, at least annually, to evaluate growth, function, and symptoms is warranted. A palpable solitary nodule or dominant nodule in a multinodular gland should be evaluated by FNAB or excisional biopsy (Chapter 14.7). Goiter with compressive symptoms requires CT or MRI evaluation and referral for probable surgery. Further assess a goiter associated with an abnormal metabolic state as outlined for hypothyroidism (Chapter 14.4) or thyrotoxicosis (Chapter 14.8). Thyroid hormone suppression of any goiter type is controversial, and the risks associated with subclinical hyperthyroidism must be included in the risk-to-benefit analysis (5).
References
1. Petrone LR. A primary care approach to the adult patient with nodular thyroid disease. Arch Fam Med 1996;5:92–100.
2. Siminoski K. Does this patient have a goiter? JAMA 1995;273:813–817.
3. Peter HJ, Burgi U, Gerber H. Pathogenesis of nontoxic diffuse and nodular goiter. In: Braverman LE, Utiger RD, eds. Werner and Ingbar’s the thyroid, 7th ed. Philadelphia: JB Lippincott, 1996:890–895.
4. Tan GH, Gharib H. Thyroid nodular disease: diagnostic evaluation and management [Letter]. Arch Intern Med 1997;157:575.
5. Gharib H, Mazzaferri EL. Thyroxine suppressive therapy in patients with nodular thyroid disease. Ann Intern Med 1998;128:386–394.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Neck Mass/Thyroid Enlargement:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Patients often present for evaluation of a “neck mass” that is a normal structure such as the hyoid, and they will insist that it is new or asymmetric.
With thyroid enlargement, the mass will be low in the neck and extend across the midline. Occasionally, a prominent thyroid nodule will mimic a lymph node but is in an atypical location. The thyroid gland rises and falls with swallowing. The only other structure to do this is a thyroglossal duct cyst.
In a multinodular goiter, a malignancy should be suspected when there is a dominant nodule or cervical adenopathy.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Thyroid enlargement:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical assessment by inspecting the patient’s trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. (See Palpating the thyroid gland, page 650.)
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is usually continuous.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Thyroid enlargement:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
The patient's history commonly reveals the cause of thyroid enlargement. Important data includes a family history of thyroid disease, onset of thyroid enlargement, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Begin the physical examination by inspecting the patient's trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. To palpate the thyroid gland, you'll need to stand behind the patient. Give the patient a cup of water, and have him extend his neck slightly. Place the fingers of both hands on the patient's neck, just below the cricoid cartilage and just lateral to the trachea. Tell the patient to take a sip of water and swallow. The thyroid gland should rise as he swallows. Use your fingers to palpate laterally and downward to feel the whole thyroid gland. Palpate over the midline to feel the isthmus of the thyroid.
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is often continuous.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Decreased Activity Level - Case 2-1: 15-Year-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.2°C; RR, 16/min; HR, 110 bpm; BP, 100/60 mm Hg
Weight and height, 25th percentile
On examination, she appeared pale and tired but was not toxic-appearing. She
answered questions appropriately. The head and neck examination revealed pale
conjunctiva. She did not have any papilledema. Her lungs were clear to
auscultation. Cardiac examination revealed tachycardia but no murmurs or other
abnormal heart sounds. Her abdomen was soft with normal bowel sounds. There was
no hepatosplenomegaly. Capillary refill was delayed at 3 seconds. Her
neurologic examination was normal. Of particular interest, her cranial nerve
examination and motor strength were normal.
IV. Diagnostic Studies
A complete blood count revealed a white blood cell (WBC) count of 2,100 cells/mm3, including 3% bands, 45% segmented neutrophils, and 51% lymphocytes. Hemoglobin
was 5.4 g/dL, and the platelet count was 173,000/mm
3. The mean corpuscular volume (MCV) was elevated at 98.7 fL.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Decreased Activity Level - Case 2-2: 2-Week-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.5°C; RR, 32/min; HR, 142 bpm; BP, 95/65 mm Hg
Weight and height, 5th percentile
On examination, he appeared awake but hypotonic. He was thin-appearing and cried
only with stimulation. His anterior fontanel was sunken, and his lips and
mucous membranes were dry. He had decreased tear production. His lungs were
clear. The cardiac examination revealed a normal rate and rhythm without any
murmur or abnormal heart sounds. His abdomen was soft without any organomegaly.
His extremities were cool, with a 2-second capillary refill time. Both
testicles were descended. His neurologic examination revealed no focal
abnormalities.
IV. Diagnostic Studies
The WBC count was 16,300 cells/mm3, with 38% segmented neutrophils, 54% lymphocytes, and 6% monocytes. The
hemoglobin was 18.2 g/dL. The platelet count was 658,000/mm
3. The results of the basic metabolic panel revealed the following: sodium, 115
mEq/L; potassium, 7.7 mEq/L; chloride, 81 mEq/L; bicarbonate, 16 mEq/L; blood
urea nitrogen, 31 mg/dL; creatinine, 1.0 mg/dL; glucose, 89 mg/dL; and calcium,
10.7 mg/dL. The serum ammonia level was 39
µg/dL. Lumbar puncture revealed 1 WBC/mm3. The cerebrospinal fluid (CSF) glucose and protein concentrations were normal.
Cultures of CSF, blood, and urine were obtained.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Decreased Activity Level - Case 2-3: 3-Month-Old Girl:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.4°C; RR, 30/min; HR, 156 bpm; BP, 100/80 mm Hg
Weight and height, 50th percentile
On examination she was alert but had a weak cry. Her head and neck examination
was remarkable for bilateral ptosis and decreased facial expression. Cardiac
and pulmonary examinations were normal. Her abdomen was distended but soft. On
neurologic examination, she had a weak gag and poor tone. Her deep tendon
reflexes were intact.
IV. Diagnostic Studies
Laboratory testing revealed a WBC count of 10,100 cells/mm3, with 33% segmented neutrophils, 56% lymphocytes, and 8% monocytes. Hemoglobin
was 11.7 g/dL; platelets, 490,000/mm
3; sodium, 139 mmol/L; potassium, 4.9 mmol/L; chloride, 106 mmol/L; carbon
dioxide, 18 mmol/L; blood urea nitrogen, 12 mg/dL; creatinine, 0.3 mg/dL; and
glucose, 58 mg/dL. A negative inspiratory force was measured at 20 cm H
2O.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Decreased Activity Level - Case 2-4: 11-Month-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 40.3°C; RR, 46/min; HR, 183 bpm; BP, 99/41 mm Hg
Weight and height, 75th percentile
On examination, he was lethargic and minimally responsive to painful stimuli.
The head and neck examination did not reveal any signs of external trauma. His
gaze was dysconjugate, but pupils were reactive from 3 mm to 2 mm bilaterally.
He had sunken eyes and dry mucous membranes. Respiratory examination revealed
shallow, labored respirations with moderately increased work of breathing. He
had intercostal and substernal retractions as well as abdominal breathing.
Breath sounds were coarse to auscultation. Cardiac examination was significant
for the tachycardia; there was no murmur or abnormal cardiac sounds. Abdominal
examination revealed hypoactive bowel sounds but no tenderness or
hepatosplenomegaly. There were no masses. Rectal examination revealed gross
blood. Neurologic examination was significant for overall hyoptonia and
unresponsiveness. Cranial nerves were intact and deep tendon reflexes were 2+
and symmetric. He had an intact gag reflex.
IV. Diagnostic Studies
In the emergency department, blood, urine, and CSF cultures were obtained.
Additional laboratory studies revealed a WBC count of 13,400 cells/mm
3, with 11% bands, 63% segmented neutrophils, 34% lymphocytes, and 2% monocytes.
Hemoglobin was 6.6 g/dL; platelets, 195,000/mm
3; sodium, 131 mmol/L; potassium, 5.8 mmol/L; chloride, 101 mmol/L; carbon
dioxide, 18 mmol/L; blood urea nitrogen, 19 mg/dL; creatinine, 0.7 mg/dL; and
glucose, 57 mg/dL. His prothrombin time (PT) was prolonged at 16.4 seconds, and
his activated partial thromboplastin time (PTT) was 29.1 seconds. Serum and
urine toxicology screens were negative.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Decreased Activity Level - Case 2-5: 9-Year-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.5°C; RR, 26/min; HR, 86 bpm; BP, 120/70 mm Hg; SpO2, 97% in room air
On examination he was asleep but was easily arousable. His head was atraumatic,
but he had occipital pain with forward neck flexion. His occiput was diffusely
tender, but no bony defects were palpated. Pupils were 4 mm and reactive to 2
mm. A funduscopic examination was attempted but was unsuccessful. Kernig
's and Bruzinski's tests were negative. The remainder of his head and neck examination was
normal. His lungs, cardiac, and abdominal examination findings were normal as
well. His neurologic examination revealed that the cranial nerves were intact.
He was able to follow commands and to respond appropriately.
IV. Diagnostic Studies
A head computed tomographic (CT) study was obtained and revealed a left-sided
parietal intracranial hemorrhage, mild hydrocephalus, asymmetric ventricles
with the left ventricle being larger than the right, and blood in the fourth
ventricle. A complete blood count and serum electrolytes were normal. Serum and
urine toxicology screens were negative.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
Decreased Activity Level - Case 2-6: 20-Month-Old Boy:
III. Physical Examination
(Pediatric Complaints and Diagnostic Dilemmas)
T, 37.0°C; RR, 27/min; HR, 75 bpm; BP, 100/68 mm Hg
Weight, 10th percentile; height, 50th percentile
On examination, he was somnolent but arousable. He fell asleep as soon as he was
no longer being stimulated. His head was normocephalic and atraumatic. His
tympanic membranes were pearly gray bilaterally, without hemotympanum. His
mucous membranes were moist. His neck was supple, and there was full range of
motion. His lung and cardiac examinations were normal. His abdomen was soft.
There was no abdominal tenderness, masses, or organomegaly. His extremities
were warm and well perfused. His neurologic examination revealed a Glasgow coma
score of 13 but was otherwise normal.
IV. Diagnostic Studies
A complete blood count revealed 12,100 WBCs/mm3 (86% segmented neutrophils, 9% lymphocytes, and 5% monocytes). Hemoglobin was
7.4 g/dL, and the platelet count was 851,000/mm
3. The MCV was low at 55 fL. Basophilic stippling was noted on the peripheral
blood smear. Samples were sent for a serum lead determination and hemoglobin
electrophoresis. Serum electrolytes and transaminases were normal. A lumbar
puncture revealed WBCs, 4/mm
3; RBCs, 4,365/mm3; glucose, 82 mg/dL; and protein, 31 mg/dL. A urine toxicology screen was
negative. Additional laboratory evaluation revealed a PT of 13.0 seconds and a
PTT of 36.6 seconds.
» READ BOOK EXCERPT ONLINE »
Source: Pediatric Complaints and Diagnostic Dilemmas, 2003
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