Part One: Professional Practice
I would ensure that the results obtained from each patient are correct, reproducible, and reproducible through quality assurance. Quality would lead to reliability, timeliness, and accuracy of reported laboratory test results. Accurate results would reduce treatment complications, unnecessary treatment, delayed correct diagnosis, and the need for additional unnecessary diagnostic testing. Diagnostic errors and delayed diagnosis are prevalent in many health care settings and harm a high number of patients. Such consequences may lead to increased costs and wasted personnel effort resulting in poor health outcomes. The pathology laboratory has a complex system that involves many activities and people. Additionally, quality assurance in pathology diagnostics needs attention to detail in an approach of a multidisciplinary perspective. The complicated system requires that all the procedures and processes are appropriately performed. Therefore, the quality management system is necessary to ensure that high levels of reliability and accuracy are achieved.
Quality assurance would assure that all aspects of pathology procedures, including organizational processes and structure, are addressed to guarantee quality. The quality framework would underpin patient safety by having a patient-focused approach that responds to their values, needs, and preferences. Quality laboratory diagnoses will need a holistic approach that will encompass workforce development, enhancement of laboratory infrastructure, education and training, and practice and quality standards. Other factors that can ensure quality in the laboratory include quality control procedures, laboratory environment, record keeping, communications, competent and knowledgeable personnel, and good quality equipment and reagents. Therefore, i would ensure that the results obtained from each patient are correct, reproducible through quality assurance of the processes and procedures involved in pathology laboratory.
Importance of the procedures
Pathology refers to the study of disease, and getting an accurate diagnosis is a significant aspect in healthcare as it provides a basis for informed and reliable decisions. The discipline has provided knowledge that has enhanced diagnostics tests that are applied in clinical practice. The tests are conducted on cells, body fluids such as urine, blood, saliva, sweat, and sputum as well as on body tissues. The diagnostic role played by pathology laboratories is vital for the effective functioning of the health care system. Fleming et al. (2018) point out that 66% of oncologists and cardiologists in the U.S and German make their clinical decision based on in vitro diagnostic analysis. Moreover, pathology aids clinical care through prognosis and disease severity assessment, such as cancer histopathology. Such information is required when managing the treatment plans for patients.
Pathology also plays a vital role in assessing response to treatment, such as when evaluating blood levels markets when analyzing renal function for patients suffering renal failure. Pathology also enables quality assurance in health care. For instance, in 2013, autopsy records showed about 20% discrepancy between pre-mortem diagnosis and autopsy diagnosis. (Fleming et al. 2018). Similarly, by examining surgical specimens, surgeons learn if excising tumors correctly. Microbiological culturing can also help physicians accurately identify what caused a fever. It can also contribute to illness surveillance by identifying new diseases. Further, pathology helps in maintaining disease registries to inform relevant parties in the national health policy. It also plays an essential and integral role in the legal system forensics around the world.
Hashimoto’s Thyroiditis
Clinical History
A 38-year-old female patient presents to her GP, complaining of fatigue, hypersomnia, myalgia, dyspnoea, and constipation. She revealed that she had recently found it difficult to concentrate, often felt confused, was regularly forgetful, and suffered from mood swings and depression. She frequently described feeling cold and suffering from dry skin. She also revealed that she has a loss of appetite, and, despite this, physical examination revealed noticeable weight gain since her previous visit. The GP noticed that the patient had a puffy face and hoarseness to her voice. The patient has a history of type 2 diabetes and hypertension. Family history revealed that the patient’s mother and older sister have both been diagnosed with hypothyroidism. The GP ordered a thyroid function test panel, including the following tests, thyroid stimulating hormone (TSH) level, free thyroxine (FT4) level, and free triiodothyronine (free T3).
Risk factors
Hashimoto’s disease refers to an auto-immune disorder whereby the immune system attacks healthy tissue within the thyroid gland. The resulting inflammation impairs the thyroid leading to the insufficient production of thyroid hormones. Hashimoto’s thyroiditis commonly causes hypothyroidism. Studies indicate that the disease’s risk factors have both genetic and non-genetic components. Hu and Rayman (2017) explain that environmental factors, immune disorders, and genetic susceptibility contribute to the disease’s development. The condition is more likely to affect women than men between the ages of 30- 50 years. Additionally, suffering from other auto-immune illnesses such as lupus, Sjogren syndrome, celiac disease, Addison’s disease, type 1 diabetes, and rheumatoid arthritis increases the susceptibility for Hashimoto’s thyroiditis. Several inherited genes are linked with Hashimoto’s disease, including HLA- DR5 and HLA-DR3, which are common with Caucasians. Thus, there is a high likelihood of developing the disease if it is prevalent in the family. Environmental triggers include iodine intake, smoking, emotional stress, exposure to certain chemicals, some type of medications, and infection. Iodine deficiency or excess might aggravate the symptoms. Thus, supplemental iodine, in addition to the consumption of foods with high iodine levels such as kelp, seaweed, and dulse, can enhance the symptoms since iodine fuels auto-immune antibodies. Pregnancy often affects the thyroid glands, and some women can develop Hashimoto’s thyroiditis during their later stages in life. Additionally, radiation therapy can also cause the disease. Environmental toxicants, including polyaromatic hydrocarbons used in various industrial processes, can also provoke thyroid autoimmunity.
Tests.
Physicians can test for the disease if the patient is feeling tired, constipated, have dry skin and dry skin, or have previous issues with thyroid problems. The diagnosis is based on the symptoms and signs of the patient, the medical history, as well as the blood test that evaluates the levels of the thyroid hormones. A diseased thyroid gland indicates plasma cell infiltration and diffuse lymphocytic whereby lymphoid follicles form due to follicular hyperplasia and a damaged follicular basement membrane. Thyroid antibodies are seen, and thyroid parenchyma atrophy is evident.
Principle for thyroid-stimulating hormone test
One of the tests that the general physician ordered was the function test panel for thyroid-stimulating hormone. Thyroid-stimulating hormone or TSH is made in the pituitary gland and stimulates the thyroid to release T4 and T3 hormones. THS is the preferred initial assessment when evaluating thyroid function. It is a blood test that is used to assess hyperthyroidism or hypothyroidism. High THS levels indicate that an underactive thyroid leading to hypothyroidism since the pituitary gland produces more TSH to stimulate the thyroid to make more thyroid hormones. Conversely, low TSH levels indicate an overactive thyroid due to the excessive production of thyroid hormone. Normal TSH levels range between 0. 4and 4.0 mu/L (UCLA 2020). The results from the laboratory indicate that the patient has no symptoms of hyperthyroidism or hypothyroidism. The symptoms associated with hyperthyroidism due to an overactive thyroid gland include increased heart rate, weight loss, puffiness, bulging eyes, hand tremors, and anxiety. Hyperthyroidism can also be caused by high iodine intake. On the other hand, the symptoms associated with hypothyroidism include weight gain, hair loss, fatigue, irregular menstrual periods, constipation and cold temperature intolerance. Hashimoto’s disease often causes Hypothyrodism evidenced by low levels of TSH. Abnormal TSH levels require further tests, including T3 and T4 hormone tests to establish the cause of thyroid problems.
Principle for free thyroxine (FT4) test
The free thyroxine (FT4) is tested when abnormal thyroid-stimulating hormones are detected. While T3 constitutes about 10% of all thyroid hormones, the rest is made up of T4. Further, most T4 hormones are attached to proteins, with less 1% being unbound. The blood test entails measuring the unbound T4 hormones since it is a biologically relevant fraction. The thyroid and the pituitary gland have a feedback loop system whereby the TSH made in the pituitary gland drives T4 and T3 production. When thyroid hormone production declines, TSH levels rise, and when T4 and T3 levels increase, TSH levels fall.T4 consists of four iodine atoms. It is converted to T3 when an iodine atom is removed in the liver. Testing involves drawing a blood sample from veins of the arm using a needle. High levels of free thyroxine indicate hyperthyroidism due to thyroid gland overactivity. Low levels of free thyroxine indicate hypothyroidism due to thyroid gland underactive. Normal total T4 test range between 5 to 12 nanograms per deciliter while free T4 tests range between 0.8 to 2.6 nanograms per deciliter or 8.0 to 30 pmol/ L (Greco & Holloway 2020). The underlying causes of hypothyroidism include Hashimoto’s disease. The lab results indicate that the patient has normal levels of free thyroxine.
Principle for free triiodothyronine (free T3) test
The test5 evaluates the level of T3 (triiodothyronine) hormones in the blood. T3 is one of the main hormones produced by the thyroid gland. It regulates various body functions, including body temperature, digestive function, body weight, metabolic rate, nervous development and function, and muscle strength. The production and dissemination of thyroid hormones, triiodothyronine, and thyroxine are controlled by the thyroid, pituitary, and hypothalamus glands. The T3 hormone comes in two forms: those attached to proteins and those not bound to anything. The free T3 test measures the unbound T3 and checks if the T3 levels are normal. Thyrotoxicosis refers to the condition when there are excessive levels of thyroid hormones in the bloodstream. It results from thyroid gland overactivity (hyperthyroidism) and may manifest as a neck swelling due to an enlarged thyroid. Symptoms of phytotoxins are weight loss, heat intolerance, irregular menstrual cycle, tiredness, and increased bowel movements. On the other hand, low T3 levels in the bloodstream are an indication of Hashimoto’s disease and is referred to as hypothyroidism. The symptom of hypothyroidism includes low heart rate, reduced appetite, weight gain, tiredness, stiff muscles, poor memory, and reduced fertility. Typically, normal T3 results range between 75 and 195 nanograms per deciliter(Bass & Hadelman- Englert 2020). Chen, Zhou, Zhou , Yion, and Wang (2018) explain that the optimal values for free T3 should be 7.2 pmol/L. Accordingly, the patient has high T3 levels because he has a count of 7.8 pmol/L.
Other tests.
The other tests for Hashimoto’s thyroiditis include the anti-thyroid antibodies test or the thyroid peroxide antibody analysis. The antibodies usually attack TPO enzymes within the thyroid gland, gradually destroying it. TPO enzyme is found in the thyroid follicle cells and is vital in producing T3 thyroid hormones. Mehanathan, Erusan, Shantaraman, and Kannan (2019) explain that anti- TPO antibodies can be found in 90-95% of Hashimoto thyroiditis cases. Another common test is the anti-thyrog1obulin antibody testing. Thyroglobulin is an essential protein in the creation of triiodothyronine and thyroxine thyroid hormones (UCSF 2018). The antithyroglobulin antibodies damage the thyroid, thereby affecting its functions. Antithyroglobulin tests can be used to diagnose various thyroid disorders.
Treatment
The treatment for Hashimoto’s disease depends on the extent to which the thyroid is damaged to cause hypothyroidism.Patients with a high count of thyroid peroxidase antibodies but have normal thyroid functions do not need treatment. However, patients with severe hypothyroidism need treatment which comprises of hormone replacement. When the thyroid is gland is sufficiently damaged, hypothyroidism is controlled through hormone therapy. Synthetic thyroid hormones, such as levothyroxine, are administered orally. The pills are taken before the first meal in the morning. The doctor regularly monitors the thyroid levels and adjusts the medication if necessary. Surgical intervention is necessary in cases where malignant nodules are present or their us goitre with obstructive signs. Beta-blockers are also given in some cases to tackle heart conditions. Untreated hypothyroidism can lead to heart problems, bone density loss, and stroke. Early diagnosis, coupled with levothyroxine replacement therapy, can help patients attain normal thyroid levels. The prognosis, however, does not always enable normal functioning. Ihnatowicz, Drywien, Wator and Wojsiat (2020) explain that there is need for dietary management in the treatment because of observed deficiencies for selenium, copper, potassium, zinc, magnesium, iron, vitamin B, A, C and D. Therefore, the management of the illness requires a diet that is focused on providing support for the immune system by regulating inflammatory processes while avoiding problematic food antigens.Due to insufficient energy intake among Hashimoto’s disease, patients should take wholemeal proteins sourced from unprocessed products that can assist in reducing body weight because resting metabolic rate reduces with the declining thyroid function. Moreover, Protein malnutrition can intensify iodine deficiency, which increases thyroid gland damage (Ihnatowicz et al. 2020). Therefore, the treatment of Hashimoto’s disease entails hormone therapy and dietary management.