Answer:
d. Measure thyroid-stimulating hormone level
Explanation:
The most suitable next step in management of this patient is to measure a thyroid stimulating hormone, or thyrotropin level.
This patient's apparent treatment refractory dyslipidemia is most likely contributed by undiagnosed thyroid disease. Despite sticking to the treatment with atorvastatin, his LDL AND total cholesterol are raised.
Additionally, there are some clinical signals that give an idea about the diagnosis of hypothyroidism especially fatigue and constipation.
Hypothyroidism is concerned with and is a very common secondary cause of dyslipidemia and thyrotropin level measures are indicated.
Hyperlipidemia may show better results to thyroid stimulating hormone.
Hence option D is the right answer.
Glutamine and glutamate are the primary nitrogen donors for biosynthetic reactions in the cell. Glutamine is an α-amino acid that is used in the biosynthesis of proteins. Its side chain is similar to that of glutamic acid, except the carboxylic acid group is replaced by an amide. It is classified as a charge-neutral, polar amino acid. It is non-essential and conditionally essential in humans, meaning the body can usually synthesize sufficient amounts of it, but in some instances of stress, the body's demand for glutamine increases, and glutamine must be obtained from the diet. Glutamate is generally acknowledged to be the most important transmitter for normal brain function. Nearly all excitatory neurons in the central nervous system<span> are glutamatergic, and it is estimated that over half of all brain synapses release this agent. Glutamate plays an especially important role in clinical neurology because elevated concentrations of extracellular glutamate, released as a result of neural injury, are toxic to neurons</span>
