In Elizabeth Mac Namara's case: Secondary hypothyroidism has not been excluded. In this case TSH alone should not be used to rule out hypothyroidism- measure fT4 or TT4 in the first instance.
Martin Myers
Preston and Chorley Hospitals
-----Original Message-----
From: p=NHS NATIONAL
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Sent: 08 August 2000 01:11
To: p=NHS NATIONAL INT;a=NHS;c=GB;dda:RFC-822=drtahir(a)cyber.net.pk;;
p=NHS NATIONAL
INT;a=NHS;c=GB;dda:RFC-822=acb-clin-chem-gen(a)mailbase.ac.uk;
Subject: Re: Unexpected high CK
Thank you for all your suggestions to date. I will give you a review of
several questions I was asked and the information I have.
Several people commented that a CK from Afro-americans has a higher reference
but in view of the fact that it is twenty times our upper limit of normal I do
not think this is the cause.
Several asked about his TSH. It was done by his rather good GP prior to his
referal and it was 3.4 (mid reference range) Others commented on the
possibility of macro-CK. I had asked for electrophoresis to define its origin
and it was all CK-MM no BB and no macro. He stated he was taking no drugs but
I will phone him and confirm he is taking no statins specifically. Some people
suggested a muscle biopsy others the possibility of a deep thigh abscess. I
will send him on for a consult and let you know if anything turns up.
Thank you again for all your suggestions it was very helpful to me.
Elizabeth
Tahir Naeem Khan wrote:
> Have checked for presence of an abscess in deeper tissues planes involving
> muscles. The symptoms at times are mild and non specific especially if it
> involves thigh.
>
> Elizabeth Mac Namara wrote:
>
> > I was wondering if you could help me I was refered a patient on whom his
> > GP did a CK toal for somewhat spurious reasons and found it to be high
> > about 3000 (about twenty times our upper limit of normal). He is
> > essentially normal otherwise. Originally I was sure he would turn out to
> > be a body builder or heavy manual worker. Al clues have been negative it
> > is all muscualr in origin. He has no complaints, originally from
> > Trinidad but has lived and worked in Canada for more than 10 years. He
> > is 56 years of age and while he used to work out and play active sports
> > he has not had this sort of activity for some years. I would appreciate
> > any help you could give me especially if I am missing something very
> > obvious.
> >
> > Elizabeth Mac Namara
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