CytoCaré

20/04/2025

20/04/2025

Euthyroid hyperthyrotropinemia

It is a condition where thyroid-stimulating hormone (TSH) levels are elevated, but thyroid hormone levels (T4 and T3) and clinical symptoms of thyroid dysfunction are absent. This means the body is producing a higher than usual amount of TSH, even though the thyroid gland is functioning normally and there are no signs of thyroid problems.

Causes of Euthyroid Hyperthyrotropinemia:
1) Iodine deficiency:
Iodine is essential for thyroid hormone production, and a deficiency can lead to the pituitary gland overproducing TSH in an attempt to stimulate the thyroid.
2) Genetics:
Some individuals may have genetic mutations that affect the TSH receptor, leading to a reduced response to TSH and a need for the pituitary gland to produce more.
3) Pituitary disorders:
Certain pituitary problems can cause increased TSH secretion, even with normal thyroid hormone levels.

4) Acquired alterations in thyroid binding proteins:
Changes in how the body binds to thyroid hormones can affect T4 and T3 levels without affecting the thyroid gland's function.

5) TSH resistance:
In some cases, the thyroid gland may not respond properly to TSH, leading to elevated TSH levels without causing thyroid dysfunction.

6) Other factors:
Certain medications, illnesses, and other conditions can also affect TSH and thyroid hormone levels.

Clinical Significance:
1) Misdiagnosis and unnecessary treatment:
In the past, euthyroid hyperthyrotropinemia could lead to misdiagnosis and unnecessary treatment for hypothyroidism.
2) Potential for long-term complications:
Some individuals with persistent euthyroid hyperthyrotropinemia may be at a slightly increased risk of developing subclinical hypothyroidism later in life.

Diagnosis and Management:
1) Blood tests:
Diagnosis involves measuring TSH and thyroid hormone levels (T4 and T3).
2) Further investigation:
Depending on the cause, further investigations may be needed to determine the underlying reason for the elevated TSH levels.
3) Monitoring:
Regular monitoring of TSH and thyroid hormone levels may be recommended to assess for any changes in thyroid function.

4) Treatment:
Treatment is typically focused on addressing the underlying cause of the elevated TSH levels, such as iodine supplementation or managing any genetic or pituitary disorders.

12/04/2025

TSH Receptors are funniest of all G protein coupled receptors!
Not only it binds to TSH, it has affinity for TSHR - stimulating antibodies (TSAb), Thyroid-blocking antibodies (TBAb) as well as neutral antibodies.

And then they have affinity for closely related LH and Chorionic Gonadotropin that also activate them when present at high levels.

That's not all, they also have constitutive activity even without any ligand to stimulate them!! , a phenomenon not shared by closely related receptors of LH, FSH or Chorionic Gonadotropin.

Guess it reminds of someone almost every men on earth is doomed to face 👻🤣

11/04/2025

The single most useful flowchart from Harrison's Principles of Internal Medicine that helped diagnose so many cases over the decade.

Assessment of Hyponatremia.

31/01/2025

PrP is a regenerative therapy for Osteoarthritis, commonly of Knee & shoulder joints. With research & studies continuous in process to determine methods to optimize its effect, it has been developed to work better. The cost of single injection in USA is 1000$/84000₹ & around 12000 to 18000₹ in various hospitals in India. We at Cytocare' are happy to provide a better enriched version of Prp (Ultra-Prp) at fraction of average cost @3000 - 4000₹ for the benefit of our patients.
It's a nearly painless walkin-walkout opd process that takes average 30 mins.

26/11/2024

Hematopoetic Stem Cells : A simple summary
DNA sequencing techniques suggest that a typical adult human has approximately 50,000 Hematopoetic Stem Cells (HSCs). One stem cell is capable of producing about 1000000 (10^6) mature blood cells after 20 cell divisions.
In humans, HSCs are capable of about 50 cell divisions (the ‘Hayflick limit’), with progressive telomere shortening with each division affecting viability. Under normal conditions most HSCs are dormant, with at most only a few percent active in cell cycle on any given day. Any given HSC enters the cell cycle approximately once every 3 months to 3 years. With ageing, the number of stem cells falls and the relative proportion giving rise to lymphoid rather than myeloid progenitors also falls. Stem cells also accumulate genetic mutations with age, an average of 8 exonic coding mutations by age 60 years (1.3 per decade). These, either passengers without oncogenic potential or drivers that cause clonal expansion, may be present in neoplasms arising from these stem cells.

& Yes, Morphologically, HSCs have the appearance of small to medium sized lymphocytes, simply making them impossible to identify microscopically!

19/10/2024

This is what Natural killer cells look like after IL12/15/18 activation.
These NK cells are called CIML (Cytokine Induced Memory Like) NK cells and have much longer average life than normal NK cells and have cytotoxic properties against Cancer Stem Cells. They are tough to isolate & generate but have potential to induce regression in metastatic tumors.
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03/09/2024

24/P4
Differential diagnosis of Anterior Mediastinal Mass: (7Ts)

1)Thymoma/thymic carcinoma
2)Thyroid (goitre/cancer)
3)Thoracic aortic aneurysm
4)T cell/Anaplastic/DLBCL lymphoma
5)Teratoma & germ cell tumours
6)Testicular cancer metastasis
7) Thymic/Bronchogenic Cysts

01/09/2024

*24/P3
Chronic kidney disease (CKD) is characterized by a reduction in GFR over a period of 3 or more months (normal GFR is >90–120 mL/min). It arises from a progressive impairment of renal function with a decrease in the number of functioning nephrons; generally, patients remain asymptomatic until GFR reduces to below 15 mL/min (stage V CKD).
Common causes of CKD are
(1) diabetes mellitus
(2) hypertension
(3) glomerulonephritis
(4) renovascular disease
(5) chronic obstruction or interstitial nephritis
(6) hereditary or cystic renal disease

01/09/2024

*24/P2
Causes of fasting hypoglycemia:

1. Hyperinsulinemic states:
-Insulin reaction/ sulphonylurea overdose (commonest cause)
-Autoimmune hypoglycemia
-Surreptitious use of insulin/ sulphonylureas
-Pancreatic β-cell tumours (insulinoma)

2. Non-hyperinsulinemic states:
-Reduced hepatic gluconeogenesis- liver disease/inborn errors of metabolism

-Renal insufficiency (kidney contributes to gluconeogenesis too)

-Alcohol excess, which increases the activity of alcohol dehydrogenase (consuming NAD+) and thereby limits the conversion of lactate to pyruvate, which is a gluconeogenic substrate

-Non-pancreatic tumours (e.g. retroperitoneal fibrosarcoma) that release IGF-2, which can activate the insulin receptor.

30/08/2024

* 24/P1
Common causes of polyuria and polydipsia include
- diabetes mellitus
- diabetes insipidus
- hypercalcemia
- & primary polydipsia.