Effect of bicalutamide; an antiandrogen, on testicular weight in adult rats

To study the effect of Bicalutamide on testicular weight in adult rats. Study Design: Laboratory based randomized controlled trial. Anatomy Department, Armed Forces Postgraduate Medical Institute [AFPGMI], Rawalpindi, Pakistan in collaboration with National Veterinary Laboratories [NVL], Islamabad, Pakistan from April to May 2008. Forty adult male healthy Sprague Dawley rats with no physical deformity weighing 200-300 grams were randomly divided into two groups [A and B], each consisting of 20 animals each. Group A was taken as control group and was administered 5 ml of distilled water orally daily for 24 days while group B [experimental group] was given 5 ml of distilled water daily containing bicalutamide 10 mg/kg/day for 24 days. All the animals were sacrificed on the next day after the last dose. The testes were taken out and weighed. In addition to initial and final weights of the animals, weights of right and left testes were also taken, and their average was taken as a reading for that animal. Statistically significant difference was found in reduction of testicular weights in the testes of experimental group [1.112 +/- 0.018 g] when compared with the control group [1.169 +/- 0.011 g]. The results obtained showed that the mean testicular weight of the testes was significantly reduced in the experimental group thus confirming that bicalutamide reduces testicular weights in the Sprague - Dawley rats

Effect of hypothyroidism on lipid profile in asymptomatic newly diagnosed patients

Hypothyroidism is a very common endocrine problem. It can be either overt or subclinical. Subclinical hypothyroidism predisposes to overt hypothyroidism. Hypothyroidism leads to hypercholesterolaemia because of reduced activity of lipoprotein lipase and thus increases the cardiovascular risk. The objective of this study was carried out to find the lipid profile in hypothyroid patients in asymptomatic previously undiagnosed cases and to correlate different components of lipid profile with TSH and ft[4]. This is a case control study consisting of 82 hypothyroid patients with age and gender matched controls selected through convenient sampling from Chemical Pathology Department, Army Medical College, Rawalpindi and National University of Sciences and Technology [NUST], Islamabad between May and October 2012. Data were recorded using specially designed pro forma and analysis was carried out on SPSS 17. Among the 82 hypothyroid patients, 62 were females while 20 were males. Mean age of patients was 40.6 +/- 11.7 years. Hypothyroid patients showed a dyslipidaemic picture and all the components namely total cholesterol, triglycerides, low density lipoprotein and high density lipoprotein were significantly raised when compared with the controls. TSH showed significant positive correlation [p value] with total cholesterol, low density lipoprotein and high density lipoprotein. Hypothyroid patients show a dyslipidaemic picture, thus increasing the risk for cardiovascular complications. A hypothyroid patient must be screened for lipid abnormalities, while in case of unexplained hyperlipidemia, thyroid screening must be performed

Inverted papilloma of ureter: a rare cause of hydronephrosis

A case of hydronephrosis with a rare underlying cause in a 35 years old male is described. He reported with pain in the left lumbar region with a past history of left ureterolithotomy. The ultrasound and IVU studies were suggestive of left hydronephroureter. CT Scan showed left hydronephroureter with narrowing at the lower end of left ureter. Ureterorenoscopy [URS] confirmed polypoidal lesions in the left lower ureter, completely obliterating the lumen and involving the whole circumferential wall of the lower ureter. The biopsy of the lesion revealed an inflammatory polyp. Accordingly open surgical intervention was planned. Excision of the lower third of left ureter with ureteric reimplantation was done with a Boari flap. The histopathology report of the lower third of ureter confirmed inverted papilloma of ureter. The patient made a smooth postoperative recovery

Efficacy of disposable spinal needle in diagnostic bone marrow aspiration

To see the efficacy of disposable spinal needle in diagnostic bone marrow aspiration. Observational study. Department of Haematology, Military Hospital and Army Medical College, Rawalpindi from 1st October 2008 to 31st September 2009. A total of 324 bone marrow aspirations were performed after obtaining informed consent. The study included both male and female subjects and was not restricted to a particular age group. After detailed clinical history and physical examination, blood counts were performed on Sysmex KX-21 hematology analyzer. Smears were examined to assess the indications for bone marrow aspiration. The procedure was conducted at posterior iliac spine in all cases except children under 2 years of age, for which tibia was the preferred site. A 16-gauge spinal needle was used, under sterile conditions using Lignocaine 2% as a local anesthetic. Leishman Stain was used to stain the slides. Pearls reaction and cytochemical stains were used where required. Once prepared, the slides were examined under light microscope and the diagnosis was made in light of both the clinical presentation and microscopic findings. The results were analyzed on SPSS version 17.0. Out of 324 bone marrow aspirations diagnosis was possible in 295 cases. The most frequently diagnosed conditions were anaemia [Megaloblastic, Iron deficiency, Anaemia of chronic disorder], Leukemias [Acute Leukemias and Chronic Leukaemias] and reactive changes in bone marrow secondary to infection. Disposable spinal needles are convenient, user-friendly, readily available [even in remote areas] and ensure sterilization in bone marrow aspiration

Comparison of serum calcium estimation by direct colorimetric and volume / volume colorimetric methods based on O-cresolphtalein principle

Calcium is the most abundant mineral and fifth most common element in the body. There are many different methods for estimation of serum calcium like spectrophotometeric, ion selective electrode [ISE] and atomic absorption methods. Aim of our study was to compare serum calcium estimation by using direct colorimetric and volume / volume colorimeteric [v/v] methods based on o-Cresolphthlein principle. The study was performed in a tertiary care laboratory in Rawalpindi from March to June '2011. It was a comparative prospective study. Seventy commercial quality control samples of Randox laboratories were simultaneously tested by both the methods. Results were analyzed on SPSS version 17. In normal controls, the v/v method kit gave the mean result of 2.34 mmol/L +/- 0.04 with a CV of 1.70% while with the direct colorimetric method kit the values were 2.31 mmol/L +/- 0.03 with a CV of 1.30%. In abnormal controls, v/v method kit gave the mean value to be 3.09 mmol/L +/- 0.04 with a CV of 1.29% while with the direct colorimetric method kit, the mean value was 3.07 mmol/L +/- 0.03 with a CV of 0.97%. Both the kits are recommended for use in a tertiary care laboratory as the precision and accuracy of both kits is comparable. But the volume / volume colorimetric kit is more cost effective

Effect of hypertension on body mass index and total cholesterol levels as risk factors in ischemic heart diseases

Dyslipidaemia and hypertension are important predisposing factors leading to cardiovascular diseases. Obesity also increases the risk of hypertension, coronary artery disease and dyslipidaemia. Purpose of this study was to find out a relationship between body mass index and total cholesterol levels in 100 hypertensive patients. Study was performed in Chemical Pathology Department of Army Medical College, Rawalpindi in collaboration with Department of Medicine, Combined Military Hospital, Rawalpindi. It is a cross-sectional study and simple non-probability random sampling was used. Hundred hypertensive patients were included in the study. Data was recorded using a detailed proforma and analysis was done on SPSS version 17. Of the 100 hypertensive patients included in the study, there were 39 males while 61 were females. The mean age was 60.1 +/- 11.5 years. The mean blood pressure was 171 +/- 13.1/105.2 +/- 6.6 mm of Hg. Mean body mass index was 28.6 +/- 3.97. Mean of total cholesterol was 5.7 +/- 0.7 mmol/L in all the patients. Hypertension, dyslipidaemia and increased BMI increase go hand in hand with the risk of cardiovascular disease. Treatment strategies should be adopted to treat hypertension and dyslipidemia aggressively and lifestyle modifications are necessary for reducing BMI

clinico-pathological study of oral cancers

In many Asian cultures where chewing betel, paan and areca is common, oral cancer represents up to 40% of all cancers. It may arise as a primary lesion originating in any of the oral tissues, by metastasis from a distant site of origin, or by extension from a neighboring anatomical structure. A tissue biopsy and microscopic examination of the lesion confirms the diagnosis and malignancy of oral cancer. To see the clinical and histopathological pattern of oral cancer. This was a retrospective case series studies carried out at Histopathology Department of PNS Shifa Hospital, Karachi. Detailed clinical histories of the patients were recorded and their histopathology was performed using haematoxylin and eosin [H and E] stain. Clinical data collected included the age, sex of patient and intra-oral site of cancer. Histopathological data included type of cancers and their degree of differentiation. The inference was drawn from this record. The data was analysed on SPSS version 17. A total of 268 oral mucosal biopsy reports were studied which constituted 6.6% of all malignant tumours reported during this period. Among the 268 cases studied, 256 [95.5%] cases were of squamous cell carcinoma [SCC], 4 [1.5%] were of basal cell carcinoma [BCC] and 2 [0.75%] each were of adenoid cystic carcinoma, mucoepidermoid carcinoma, adenocarcinoma and undifferentiated carcinoma. amongst the SCC group, 116 [43.28%] cases were well differentiated, 128 [47.76%] cases were moderately differentiated and 16 [5.97%] cases were poorly differentiated. Tongue was the commonest site involved in 116 [44%] cases followed by buccal mucosa 88 [33.3%] cases. Squamous cell carcinoma is the predominant type of oral cancer and tongue is the commonest site of origin for these cancers. In our patients oral cancer presented at a relatively early age group

Relative changes in hepatitis-C virus RNA titre and serum ALT levels before, during and after treatment with interferon and ribavirin

Hepatitis C is commonly treated with Interferon and Ribavirin combination therapy. The aim of this study was to find the relative change in the Hepatitis C virus [HCV] RNA titre and serum alamine aminotransferase [ALT] levels before, during and after completion of treatment with Interferon [IFN] and Ribavirin therapy in HCV positive patients. This cross- sectional descriptive study was conducted from May 2010 to August 2010. Seventy hepatitis C patients reporting to the Laboratory of Army Medical College, Rawalpindi, were included in the study. Blood samples were first subjected to centrifugation and stored at -20[degree sign] C till tested. HCV RNA titre was determined by Real Time PCR while ALT estimation on serum samples was done on Selectra-E by kinetic method. The age, gender and treatment status of the patients was also recorded. In a total of 70 patients, 30% were females while 70% were males. The mean age of patients was 38 +/- 11 yrs. On applying, analysis of variance [ANOVA], we found that the change in serum ALT level was significant [F = 6.044 and p = 0.004] while it was not significant in case of HCV RNA [F = 1.93 and p = 0.153] treatment with Inj. IFN and Ribavirin. There is a definite decreasing trend in the serum ALT levels while no definite relationship of the HCV RNA level to the treatment with combination therapy with IFN and Ribavirin

Histomorphometric study of effects of bicalutamide on spermatogenesis in male rats

To study the effects of Bicalutamide on spermatogenesis in male rats. Laboratory based randomized controlled trial. Anatomy Department, Armed Forces Postgraduate Medical Institute [AFPGMI], Rawalpindi in collaboration with National Veterinary Laboratories [NVL], Islamabad from April 2008 to May 2008. Forty adult male Sprague Dawley rats weighing 200-300 grams were randomly divided into two groups, Group A and Group B, each consisting of 20 animals each. Group A was taken as control group and was administered 5 cc of distilled water orally daily for 24 days while group B [Experimental group] was given 5 cc of distilled water daily containing bicalutamide 10 mg/ kg/ day for 24 days. All the animals were sacrificed on the next day after the last dose. The testes were removed and fixed in 10% formalin and then processed for paraffin embedding. Five micron thick sections were made. Haematoxylin, Eosin and PAS stains were used. Histomorphometric analysis was done and parameters, including the tubular diameter, height of seminiferous epithelium and germ cell count were noted. Statistically significant differences were found in tubular diameter, height of seminiferous epithelium and germ cell count in testes of experimental group when compared with the control group. The results showed that the mean tubular diameter, the height of the germinal epithelium of the seminiferous tubules and the number of germ cells were significantly reduced in by the experimental group showing that bicalutamide suppresses spermatogenesis in the Sprague - Dawley rats

Bladder outlet obstruction in a 5 years boy

We report a 5 years old boy with bladder outlet obstruction secondary to a fibroepithelial polyp of prostatic urethra. The micturating cystourethrogram showed a filling defect in the posterior urethra. Cystourethroscopy revealed a polyp in the prostatic urethra proximal to the verumontanum. Transurethral resection was done and histopathology confirmed fibroepithelial polyp of the urethra

Biochemical pattern of liver function tests in hepatitis E epidemic

To evaluate the biochemical pattern of liver function tests in acute hepatitis E epidemic. Cross sectional descriptive study. Department of Pathology Army Medical College, Rawalpindi from June '09 to Dec '09. A total of 81 patients of acute hepatitis of all age groups, both male and female were included in the study. Patients who reported with symptoms of acute hepatitis and tested positive for hepatitis E IgM antibody were included. Detailed history, clinical examination and serial liver function tests [LFTs] were carried out. Weekly data of LFTs was arranged serially up to 4 weeks. The results were analyzed on SPSS version 17. The patients' age ranged from 17-59 years. Serum Alanine Transaminase [ALT] values were highest in the first 2 weeks reaching 100 times the upper limit of normal [ULN]. Similarly serum total bilirubin [TBil] reached up to 8 times ULN in the 1st week. The increase in serum alkaline phosphatase [ALP] was 2 times ULN and then returned to within the reference range in the 3rd and 4th weeks before other variables. Serum albumin levels remained unchanged. Prothrombin time [PT] was found to be prolonged. Two cases ended up fatally. Rest recovered fully and became symptom free. Hepatitis E is a serious clinical condition. LFTs play an important role in its diagnosis. There is marked derangement of LFTs. Sharp rise in serum ALT up to 100 times ULN is a significant feature and should raise the suspicion of acute Hepatitis E

rare complication of forgotten ureteral stent

A 35 years old lady presented with history of something coming out of the genitalia for the last 5 days. She also had history of pain in the left lumbar region which was initially investigated but the patient did not follow-up. About 15 years ago she also underwent left ureteric reimplantation. On examination, a stick like tube was protruding out of the urethral meatus which was fixed to the underlying vesical calculus. The calculus was evident radiologically and on ultrasound. The projecting portion of the stick like tube was cut and the vesical calculus with the inner portion of the tube was removed by open procedure. On evaluation of the specimen, it was found that the vesical calculus was fixed to the plastic tube which had concretions around it. This plastic tube had been placed after the ureteric reimplantation done 15 years age and the patients was not aware of it

need and rationale of thyroid function tests in a tertiary care laboratory

To find out the outcome of thyroid function tests in a tertiary care laboratory and to assess the rationality of thyroid function tests advice. It was a descriptive study which was carried out in a tertiary care laboratory of Rawalpindi. Patient's demographic data and clinical details were recorded. Blood samples were obtained and analysis was done. Results were analyzed on SPSS version 17. One hundred twenty seven samples of both sexes with age range 15-80 years were selected for study and non probability random sampling was done. There were 94 [74%] females and 33 [26%] males. Age range of the patients was 38.8 +/- 14.4 years. Majority of the patients were found to be euthyroid 76.38%. On basis of history, the most common symptom for which thyroid testing was advised was lethargy. For non-specific symptoms, full thyroid profile should not be advised, rather Thyroid Stimulating Hormone [TSH] should be used as a first line screening test. Full thyroid profile is an expensive test and has financial implications on both patients as well as the laboratory, so rational use o thyroid function tests is recommended

Insulin resistance and insulin secretion at varying levels of glucose

To compare the insulin resistance and insulin secretion among the subjects with impaired fasting glucose, normal glucose tolerance, impaired glucose tolerance [IGT], and type 2 diabetes mellitus by Homeostasis model assessment [HOMA]. Comparative cross-sectional study. This study carried out from January 2006 to October 2006, at the department of pathology PNS Shifa Karachi. One hundred individuals [male 69 and female 31] were subjected to oral glucose tolerance test [OGTT]. These individuals were classified into four groups, based on the results of 75-g OGTT. 1] Normal glucose tolerance [NGT]. 2] Impaired fasting glucose [IFG]. 3] Impaired glucose tolerance [IGT]. 4] Diabetes mellitus [DM]. We used the HOMA for the calculation of insulin resistance [IR] and insulin secretion [HOMA-beta cell]. The mean HOMA-IR was highest in IFG and DM. No significant difference in HOMA-IR was noted between IFG vs. IGT and DM [4.18 +/- 2.32, p>0.05]. The IGT group had significantly low HOMA-IR as compared to DM. IGT subjects had significantly high mean HOMA-beta cell function [171.1 +/- 117 p<0.003] from DM group. NGT group subjects had no significant difference in HOMA-beta cell function as compared to IFG and IGT [145.58 +/- 130.0, p>0.005]. IFG group subjects had no significant difference in HOMA-beta cell function as compared to IGT and DM [119.8 +/- 53.9 p>0.05]. The insulin resistance and insulin secretion are different at the different levels of glucose tolerance. IFG group has high insulin resistance and low insulin secretion, which is comparable to DM, while IGT group has low insulin resistance and high insulin secretion as compared to DM

Beta-thalassemia- institution based analysis of ethnic and geographic distribution, effect of consanguinity and safety of chorionic villus sampling as a diagnostic, tool for pre-natal diagnosis in selected patients

To study the ethnic and geographic distribution of Beta-thalassemia amongst the patients included and to study the effect of consanguinity in promoting this disease. Also, to establish the safety of CVS when used as a pre-natal diagnostic tool in aiding the early diagnosis of Beta-thalassemia in selected patients. Descriptive Study. PNS Shifa Karachi, from Jan 2008 to Dec 2008. A total of 223 women out of 240 that were referred from all over Sindh to PNS Shifa Hospital Karachi for susceptible gene mutations participated in the study. The standard procedure that was used in this study was trans-abdominal aspiration of chorionic villi through suction needle. The samples were then sent for further analysis to the Pathology Department at PNS Shifa Hospital Karachi. In our study population Beta-thalassemia was most prevalent in Sindhi 107 [48%] followed by Punjabi 46 [21%], 27 [12%] Pathan, and 43 [19%] Balochi. Out of 223 women, 95 were of thalassemia trait, while 85 were of thalassemia major. Fifty five percent of thalassemia trait and 56% of thalassemia major fetus parents were first cousins. The rate of pregnancy loss after performing CVS was 2.0% with no complications reported. It is concluded that highest percentage of thalassemia is in first cousins and sindhi origin families are mostly affected. However CVS is a safe and effective tool for prenatal diagnosis and subsequent counseling in selected couples

Correlation between glycated haemoglobin and random plasma glucose levels for the screening of diabetes mellitus

To find out a correlation between Glycated hemoglobin [HbA1c] and random plasma glucose levels for the screening of diabetes mellitus. Analytical cross-sectional study. This study was conducted in the Department of Pathology, Army Medical College, National University of Sciences and Technology, Rawalpindi, from January 2010 to April 2010. Three hundred and fifteen patients were included in the study. HbA1c was estimated using Ion Exchange Resin separation kit of Globe Diagnostics, as per guidelines. The Plasma samples received were analyzed on fully automated chemical pathology analyzer Selectra E for random glucose estimation by Glucose Oxidase method. The gender distribution and the relationship of age with HbA1c and random plasma glucose levels were also determined. The results were interpreted using Statistical Package for The Social Sciences [SPSS] version 17. There was a direct correlation between glycated hemoglobin and random plasma glucose levels while there was no correlation between age of the patients and the HbA1c or the age and the random plasma glucose levels. We also found that for every 1% rise in HbA1c, plasma glucose level rose by 2.3mmol/L. Glycated haemoglobin can be used as a reliable, feasible and fairly accurate tool for screening of diabetes mellitus

Clinical presentation in an outbreak of hepatitis E

In many cases of acute hepatitis, hepatitis E virus [HEV] is a common cause. Hepatitis E is a self limiting disease which shares many epidemiological, clinical and morphological similarities with hepatitis A. Both are enterically transmitted. The purpose of this study was to evaluate the clinical presentation of hepatitis E during an epidemic and correlate the clinical features with liver function tests [LFTs]. It is a cross sectional retrospective study. The study was conducted at Army Medical College [National University of Sciences and Technology] and Military hospitals Rawalpindi from July to December 2009. One hundred patients admitted to the hospital with clinical features of acute hepatitis including anorexia, nausea, vomiting, pain epigastrium, jaundice, raised serum total bilirubin [TBil] and serum aminotransferase [ALT] were included in the study. Hepatitis E in these patients was confirmed by detecting the presence of anti HEV IgM. The patients were monitored during their stay in the hospital and changes in their clinical condition were correlated with liver function tests [LFTs]. The most prominent symptoms in all patients were fatigue, nausea, anorexia, jaundice and dark urine, followed by pain epigastrium [50%], low grade fever [48%] and hiccups [2-3%]. Jaundice developed when mean total bilirubin was 127micromol/L, mean ALT was 1527 U/L and mean ALP 127 U/L. Serum bilirubin correlates with the development of jaundice. Hepatitis E presents with varying clinical features. The presentation is acute with marked anorexia, nausea and fatigue coupled with sharp rise in LFTs. Any adult presenting with acute onset of these symptoms should be investigated for LFTs and anti HEV IgM

Bone marrow aspiration: the diagnostic tool in haematological and non-haematological disorders

This study was undertaken to ascertain various clinical conditions requiring bone marrow examination and to assess its advantages in our clinical setup. This study is case series, which was carried out at the Department of Pathology, Combined Military Hospital, Sialkot Cantt from 1[st] Jun 2005 to 31[st] Dec 2007. One hundred and six bone marrow examinations were performed from 1[st] June 2005 till 31[st] Dec 2007. Patients of all age groups and gender referred for bone marrow examination were included in the study. After history, clinical examination and blood complete counts, about 0.1 and 0.2 ml of bone marrow was aspirated from posterior superior iliac spine, sternum or tibia under local anesthesia or Ketamine as per age. Well spread films were made immediately and air dried. The smear was stained with Leishman stain and Peri's stain and assessed by examination under microscope. The patient's ages ranged from 06 months to 80 years with a mean age of 38 years. Twenty five patients were children under the age of 15 years and 81 were adults. Male to female ratio was 2:1. The clinical presentation of the patients was progressive pallor [50], fever of unknown origin [13] and bleeding [6]. The common clinical situations where bone marrow examination was requested were the presence of anaemia 37[34.9%], leukaemia 25 [23.5%], myelodysplastic syndrome 7 [6.6%], multiple myeloma 5 [4.7%], chronic disorders 10 [9.4%] and non-haematological conditions 8 [7.5%]. Diagnosis was established in >/= 90% cases. Bone marrow examination remains a simple, reliable and the most effective technique in the diagnosis of many important clinical conditions.It is an important and readily accessible tool for diagnosing various haematological and non-haematological conditions. The importance of bone marrow examination is further highlighted in cases where routine investigations fail to reach a conclusive diagnosis

Role of urodynamic studies in evaluation of lower urinary tract symptoms

To emphasize the role of urodynamic studies in the evaluation of lower urinary tract symptoms and to describe the technique and report results of tracings from a urodynamic center in a tertiary care settings. Descriptive Study. This study was carried out at Armed Forces Institute of Urology, Rawalpindi, over thirty months from January 2003 to June 2005. sixty seven patients referred to the urodynamic centre of AFIU, Rawalpindi with complaints of urinary incontinence or voiding disorders were evaluated with conventional urodynamic tests. During cystometry, the detrusor activity, bladder sensation, bladder capacity and bladder compliance were measured with simultaneous urinary flow measurement in those who were able to void. Results were grouped into eight different types of urodynamic diagnoses. There were 51 females [76%] and 16 males [24%] patients. Majority of patients [48%] were in age group of 20-50 years. Ages ranged from 5-84 with a mean of 41.3 +/- 17.3 years. Majority of the patients found to have neuropathic bladder [25.3%] followed by patients with pure stress incontinence [23.9%]. In 38 female patients who presented with urinary incontinence, majority of them i.e. 16 [42.1%] were found to have pure stress incontinence on urodynamic evaluation while 11 [28.9%] patients had normal cystometric findings and 5 patients [13.1%] had hypersensitive cystometrogram signifying sensory urge incontinence while motor urge incontinence implying detrusor instability occurred in 1 patient [2.7%]. Urodynamic studies are useful in evaluation of lower urinary tract symptoms not responding to conventional medical treatment as they help clinician in identifying the underlying causes for the symptoms, and to quantify the related pathophysiological processes. Treatment of the underlying pathophysiology facilitates better treatment of symptoms

Rational thyroid screening by thyroid stimulating hormone assay

Serum thyroid stimulating hormone [TSH] estimation is an ideal investigation for thyroid disease. It gives most comprehensive information about whether a patient has a thyroid disease and what is the cause. It has been frequently observed in clinical settings that complete profile of thyroid function tests is advised for screening and vague symptoms. Aims and objectives of current study were to assess the usefulness of TSH alone as a screening tool of thyroid disease. It also evaluated the extra information generated by analysing fT3 and fT4 during screening. It was a prospective comparative cross sectional study. Adult patients referred for routine thyroid disease were selected for study. Their history was taken and detailed clinical examination was carried out. FT3, fT4 and TSH were analysed by chemiluminescence immunoassay. Results revealed that in 100% cases with normal TSH, fT3 and fT4 remained normal. Likewise in 107 cases with normal fT3 and fT4, TSH was abnormal leading to the diagnosis of sub-clinical hypothyroidism in 82 cases and sub-clinical hyperthyroidism in 25 cases. In a total of 213 abnormal TSH cases fT3 was abnormal 19 and fT4 was abnormal in 87. It was concluded that in cases with normal TSH levels there is no need of fT3 and fT4. Only patients with abnormal TSH merit detailed evaluation