Other labs

Endocrine

- thyroid

- diabetes

Thyroid hormones:

Hypothalamus:

Pituitary gland:

Thyroid:

Hypothalamus: TRH

Pituitary gland: TSH

Thyroid: T3 and T4

TRH

thyroid releasing hormone

TSH

thyroid stimulating hormone

As T4 and T3 are released....

they serve as a negative feedback loop, inhibiting more release from hypothalamus and pituitary

Endocrine thyroid symptoms

- cold/heat intolerance

- slow/rapid heart rate

- weight gain/loss

- goiter

Hypothyroidism

- dry hair

- puffy face

- goiter

- slow heat beat

- weight gain

- constipation

- cold intolerance

- possible infertility and an increased risk of miscarriage, irregular menstrual cycles

Hyperthyroidism

- hair loss

- bulging eyes

- goiter

- rapid heart beat

- weight loss

- diarrhea

- heat intolerance

- menstrual periods may occur less often, or with longer cycles

TSH normal range

0.5-5 milliunits/L

Is TSH active?

yes, it stimulates thyroid to secrete hormone

TSH HIGH value:

Do you have hypo or hyperthyroidism?

- >5 milliunits/L

- HYPOthyroid

- high TSH means the body is trying to compensate for low thyroid hormone, which is the hallmark of hypothyroidism

TSH LOW value

Is it hypo or hyeprthyroid?

- <0.5 millinuits/L

- HYPERthyroid

- thyroid is overactive, too much T3 and T4. produces less TSH

Is Free T4 thyroid gland active?

What is measured?

- probably active

- measure UNBOUND T4 in serum

High value Free T4 thyroid: Is it hyper or hypo?

high value: HYPERthyroid

Low value Free T4: is it hyper or hypo?

low value: HYPOthyroid

Is total serum T3 active?

free portion is the active form (PROTEIN BOUND)

High value total serum T3: Is it hyper or hypo?

HYPERthyroid

Low value total serum T3: Is it hyper or hypo?

HYPOthyroid

Total serum T4 thyroid gland: Is it active?

free portion

High value total serum T4: is it hyper or hypo?

HYPERthyroid

Low value total serum T4: is it hyper or hypo?

HYPOthyroid

Normal range for A1c (Glycated or glycosylated hemoglobin)

4-5.6%

How is A1c taken?

• VENOUS Blood draw or fingerstick

• NOT require fasting

Glucose is ____________ bound to hemoglobin proportionally to the _________ in serum

- irreversibly

- glucose

A1c provides a _______________ measurement of glucose

3-month measurement

Diabetes - Conversion A1c to estimated BG

A1c conversion to estimated BG

7% = 154 mg/dL

for each 1% increase = + 30 mg/dL

How are lipids measured?

venous blood draw

Total cholesterol (TC)

amount og blood cholesterol

Low-density lipoproteins (LDL)

- "bad" cholesterol

- plaque build up

- cuts off blood flow

High-Density Lipoproteins (HDL)

- "good" cholesterol

- carries LDL away from the arteries

Triglycerides (TG)

- "fat" (VLDL x5 -very low density lp)

- goes up when you eat

T/F: Triglycerides need to be tested after eating

NEED to check labs FASTING

Formula for TC

TC = HDL + LDL + (TG / 5)

Example problem for TC

TC = HDL + LDL + (TG / 5)

• HDL = 42 mg/dl

• LDL = 144 mg/dl

• TG = 148 mg /d

216 mg/dL

Another example problem for TC

TC = 225

HDL = 38

TG = 215

225 = 38 + LDL + (215 / 5)

225 = 38 + LDL +. 43

225 = 81 + LDL

225 - 81 = 144 mg/dL

Total cholesterol normal range

< 200 mg/dL

LDL normal range:

Desirable:

For higher risk:

• <130 mg/dL

• Desirable: <100 mg/dL

• For Higher risk: < 70 mg/d

HDL normal range for men

≥40 mg/dL men

HDL normal range for women

≥50 mg/dL women

Triglycerides normal range

<150 mg/dL

CRP is produced by liver in response to....

injury or infection which causes swelling (inflammation)

CRP role in inflammation

atherosclerosis (build up of plaque in arteries)

What are increased hs-CRP levels linked to?

linked to an increased risk for heart attack, stroke, and heart disease

CRP test usually _________, _______ weeks apart

- twice

- two weeks apart

High hs-CRP range >____________ can lead to ___________

- >2.0 mg/L

- increased risk of heart disease

Cardiology Natriuretic peptides

- B-type natriuretic peptide (BNP)

- N-terminal-pro BNP (NT-proBNP)

B-type natriuretic peptide (BNP)

hormone/protein released by heart and blood vessels when responding to an increase in pressure or volume

N-terminal-pro BNP (NT-proBNP

more stable BNP form that is elevated in the elderly

What do natriuretic peptides help indicate?

severity of HEART FAILURE

Physiology: Nature defense to relieve stress on the heart

• Blood vessels:

• Blood pressure:

• Heart:

• Kidneys:

• REDUCE hormones that cause...

• Blood vessels: Dilate or relaxes blood vessels

• Blood pressure: Decreases

• Heart: Decreases workload

• Kidneys: Get rid of salt and water (fluids) - cause urination

• REDUCE hormones that cause narrowing of blood vessels, increase the heart rate, or retain fluids (adrenaline, angiotensin, aldosterone)

- Normal adult range for BNP

- Is heart failure likely?

- <100 pg/ml

- heart failure NOT likely

With what range in BNP is heart failure likely?

>500 pg/ml

Troponin

protein in the heart muscle

Purpose of troponin (3)

• Detects myocardial injury

• Diagnose heart attack

• Identify risk for heart disease

Troponin's 3 subunits

- Troponin C (TnC)

- Troponin I (hsTNI)

- Troponin T(hsTnT)

Tropmyosin is a contractile protein that works with _________ and __________ proteins to cause ______________

- actin and myosin

- contractions

Troponin regulates interplay ______________ with actin and myosin needed for _________________ of the heart

- calcium

- muscle contraction

Troponin activation

Troponin C (red) binds Ca2+, which stabilizes the activated state, where troponin I (green) is no longer bound to actin. Troponin T(blue) anchors the complex on tropomyosin

How is troponin tested?

venous blood draw

What are biomarkers of troponin?

• high-sensitivity Troponin I (hsTnI)

• high-sensitivity Troponin T (hsTnT)

• These troponins are very specific to myocardial injury

cTnI

Time to increase:

Time to PEAK:

Time BACK to NORMAL RANGE:

Time to increase: 3-12 hours

Time to PEAK: 24 hours

Time BACK to NORMAL RANGE: 5-10 days

cTnT

Time to increase:

Time to PEAK:

Time BACK to NORMAL RANGE:

Time to increase: 3-12 hours

Time to PEAK: 12-48 hours

Time BACK to NORMAL RANGE: 5-14 days