[Answered]: A 30 year old female sees her physician for a…

A 30 year old female sees her physician for a routine physical and notes that she has felt tired, sluggish and fatigued for quite some time. She has noticed dry skin, hair, and being cold but has noted that it is January and this is not too abnormal for this time of year. She has gained 20+ pounds in the last 6 months but has chalked it up to winter inactivity and a general feeling of lethargy. She claims she has not noticed an increase in urination but said she does drink a lot of water so may not otherwise notice. Family history reveals lupus on her mother’s side and her grandfather had type I diabetes. Routine blood work is below: CBC: Chemistries: Urinalysis: WBC: 7.8 x 109/L Na: 133 (NR: 135-145 mEq/L) Color: Pale Yellow RBC: 4.4x 1012/L K: 4.2 (NR: 3.5-4.5 mEq/L) Clarity: Clear Hgb: 13.3g/dL Cl: 92 (NR: 96-106 mEq/L) Sp. Grav: 1.030 Hct: 40.4% Glu: 284 (NR: <100 mg/dL) pH: 5.8 MCV: 97fL Ca: 9.0 (NR: 8.5-10.5 mEq/L) Glucose: 3+ MCHC: 34% AST: 33 (NR: 10-40 U/L) Bilirubin: Neg. MCH: 29pg ALT: 47 (NR: 7-56 U/L) Ketones: Mod. Platelets: 145,000 Fe: 16 (13-17 g/dL) Protein: Trace TIBC: 332 (240-450 μg/dL) Urobilinogen: <0.2 (normal) Ferritin: 221 (12-300 ng/dL) Nitrite: Neg. TSH: 34 (NR: 0.4-4.0mIU/L) Blood: Neg. T3: 18 (NR: 80-180 ng/dL) Leuk. Est.: Neg. T4: 0.1 (NR: 0.7-1.9 ng/dL) 1. What would you consider this patient’s primary disorder to be? Justify your answer: (2) Type 1 diabetes because of the increased in take of water, glucose in the urine, high glucose in the blood, and the ketones in the urine. Also the past history of type 1 diabetes. 2. What might be a secondary disorder? Justify your answer: (2) Hypothyroidism because of the high TSH and the decreased T4. 3. How might these two disorders be related? (1) The autoantibodies from type 1 diabetes could have blocked the TSH receptors of the thyroid. If a person has a autoantibody they are more likey to develop another. 4. Why do you suppose the physician ordered a CBC, Iron Studies and Liver enzymes? (2) To rule out anemia, 5. Why is the urine specific gravity so high, despite having a pale, yellow, clear urine? (1) 6. Explain both disorders: (2)