herbolaryo
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One of the clinical manifestation of hypothyroidism is elevated liver enzymes and anemia.
1. What is the mechanism of elevated liver enzymes in hypothyroism?
2. What is the mechanism of anemia in hypothyroism?
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| medschoolmania
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what do you mean by mechanism. all i can think of for the second one is that hypthyroidsm leads to fatigue and sluggishness. decreased CO and blood volume.......you got me there..
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| herbolaryo
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This is actually a question in qbank which they did not explain further. By the word mechanism, I was trying to find out the pathophysiology behind it...
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| new_n_lost
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can you elaborate on the question or its source cos Hypothyriodism and Liver enzymes are not linked up as far as my limited knowledge goes.
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| DR_K
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i think anemia has something to do with erythropoitin production coz dec sympathetic stimulation due to dec thyroid , causes dec in erythro and so anemia(i m not sure have to double check it).
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| new_n_lost
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The sympathetics are involved in the secretion of the erythropoitein not the production of it.
I think if they will come up with a corelation it would be due to the sluggish GI motility which leads to decrease in folic acid absorption.
Not sure on that though.
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| DR_K
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yeah i meant secretion .
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| DR_K
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it cud be the relationship of iron in bound from and prduction of transferrin??????i m just trying to guess.....:S??
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| herbolaryo
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My query stems from this qbank question which was not explained in their discussion...
30 y/o woman with family history of cancer presents to the doctor office with severe weakness, fatigue, decreased sense of smell, hoarse voice,uncoordinated mov't,abnormal menstrual period and frequent urination. Her heart rate is slow, BP is 110/65 and temp 36 C (98.6F). Laboratory values show that the woman is anemic, but with normal cortisol levels and blood glucose. In addition, she has increased cholesterol, elevated Alkaline phosphatasem elevated alanine aminotransferase,elevated aspartate aminotransferase, low serum thyroxine and low TSH. WHat is the most likely diagnosis?
ANS: Primary hypothroidism...
From there, what is the pathophysio of anemia and elevated liver enzymes in hyperthyroidsm?
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| Aashi
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herbolaryo wrote:
My query stems from this qbank question which was not explained in their discussion...
30 y/o woman with family history of cancer presents to the doctor office with severe weakness, fatigue, decreased sense of smell, hoarse voice,uncoordinated mov't,abnormal menstrual period and frequent urination. Her heart rate is slow, BP is 110/65 and temp 36 C (98.6F). Laboratory values show that the woman is anemic, but with normal cortisol levels and blood glucose. In addition, she has increased cholesterol, elevated Alkaline phosphatasem elevated alanine aminotransferase,elevated aspartate aminotransferase, low serum thyroxine and low TSH. WHat is the most likely diagnosis?
ANS: Primary hypothroidism...
From there, what is the pathophysio of anemia and elevated liver enzymes in hyperthyroidsm?
Let me try:-
Anemia in Primary Hypothyroidism is usually and MCly 1)normocytic normochromic( this is a hypometabolic state)------>less o2 requirement------->less erythopietin release
2) It can be Macrocytic-------->Folic acid abasorption is affected in these guys or
3) It cud be Fe def.anemia------->coz the ladies with hypothyro frequently complains abt Menorrhagia
and yes one more cause can be autoimmunity
Primary hypothyrodism----------------->Hashimotos(AUTOIMMUNE chronic lymphocytic thyroidtis)
Any autoimmune disorder can be associated with autoabs associated somewere else in the body, say for eg:- Pernicious anemia----------------->Autoabs to Paritel cells-------->this also can explain her anemia
Autoabs to intrahepatic bileducts------------->Primary bilary cirrhosis------------>elevated liver enzymes, high lipids and cholestrol + high ALP, GGT AND IgM Igs
Even without autoabs, decreased thyroxine---------can cause increased levels of total cholesterol and LDL and a possible change in HDL due to a change in metabolic clearance
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| new_n_lost
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http://www.prep4usmle.com/forum/thread/52973/ << we had a good discussion here
So far Merck has classified Normochromic normocytic anemia of Hypothroidism as of unknown eitology. Pernicious or Hypochromic would appear on the basis of absence of folic acid and menorrhagia respectively.
The following is the theory of the P4U members or rather an inference from the discussion we have had:-
The reason normochromic normocytic is present cos of the dec O2 requirements or the hypometabolic state thus leading to less EPO production. then argument that comes to mind is that if there is anemia and a hypoxic state is developing then shouldnt the response of anemia be more release of EPO. The answer to that question is answered by none other than Papi on pg 195 RR 2nd ed. Point 1 sub part : the stimuli for EPO is severe anemia around 7mg/dl. Therefore if you find a Normochromic Normocytic Anemia in a Hypothryroidism the etiology is kinda of unknown so far if anything other than that then Etiology will be related to the type of anemia present.
Edited link
Edited by new_n_lost on 07/25/08 - 02:07 PM. Reason: Edited the linl
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| Aashi
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NNL you have pasted down the link to this page..
Edited by Aashi on 07/25/08 - 01:58 PM
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| new_n_lost
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Oh sorry edited the link.
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"never argue with a fool, they'll bring you down to their level and beat you with experience" FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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| keepgoing
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agree with aashi,PBC is associated with hoshimoto dis so this cud be the reason for such liver enzyme abnormality and anemia yeah due to hyoactive state maybe .
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