Case Study Question

Give a brief discussion on thyroid discorder?

Thyroid gland in a human’s body is the largest gland, present in the neck, above the collarbone. It is butterfly-shaped one. It is composed of numerous blood vessels. The nerves for quality of voice pass through this gland. This gland is one of the major endocrine gland that produces hormones in our body (Nlm.nih.gov, 2015).The gland takes iodine and makes it into the hormone thyroxine (T4) and trioiodothyronine (T3). They are then released into the blood. The hormone controls many activities in human body (Ward, 2007). They are fat burning, heartbeat, energy usage, protein making and many more. Most of these are in relation to the metabolic activities of the body. Thyroid disorders are common in men and women. Women are found to be more effected by thyroid disease than men. Deficiency of thyroid hormone is known as hypothyroidism and over secretion of the hormone is known as hyperthyroidism (Friedman, Scherer and Friedman, 2012).  The tests to detect thyroid problems include blood tests, scanning through radioactive ions, ultrasound, biopsy, fine needle aspiration (Thyroid Health and the Environment, 2007).

The detection of hypothyroidism and treatment of hypothyroidism by levothyroxine is the topic of discussion over here.

A 63 year old man had been complaining of tiredness and discomfort in neck. He had visited the general physician. He was also gaining weight and reached 90 kg. Increased sensitivity to cold, constipation, dry skin, muscle weakness were the other problems he had.

Patient demographics are the core of data for medical institute. It allows identification of patient and for better analysis. The patient in this case is a man. He is 63 years old. He is a native of London. His contact number is xxxxxx. His blood group is A+. He is allergic to dust and seafood. He has been visiting Dr. X for general checkups for the last 10 years. Recently he had complains regarding discomfort in neck and tiredness. He went to the doctor who referred to an endocrinologist for testing whether he had hypothyroidism or not.

The signs and symptoms in case of hypothyroidism can grow so slowly that people might think it is a part of the natural process of aging. This is because many of the signs are common in people. Opposite is true also. The symptoms are common among the different conditions and even if one has the symptoms he will not have hypothyroidism. Many people who think their symptoms are of hypothyroidism are often mistaken. They don’t have the disease when they go for a test. Recognising the symptoms is difficult.  The symptoms can be vague and mimic other certain conditions (Thyroid Health and the Environment, 2007).

Case Study

The general sign and symptoms  include weight gain, fatigue, increased sensitivity to cold, constipation, dry skin, hoarseness, muscle weakness, elevated blood cholesterol level, muscle aches, tenderness and stiffness, slowed heart rate, anaemia, constipation, etc. (Phitayakorn, 2010). Others are hair loss, irritability, muscle cramps, insomnia, muscle aches, dizziness balance problem, vertigo, heavy eyelids. There may be puffiness in eyes, face, feet, hand, and ankles. There is numbness in toes, arms, legs, fingers, back. Weight gain is a sign that can be both ways. There is a huge problem related to mental and emotional health. There are panic attacks, mental sluggishness, poor concentration, memory loss, confusion, phobias, nightmares, mood swings, depression, nervousness or anxiety, lack of confidence and feelings of resentment. A person gets easily upset during this time. He develops hearing problems too. The patient develops difficulty in swallowing, sore throats, swollen and scalloped tongue, dry mouth, sensation of lump in throat. Due to hypothyroidism, there may be deterioration in other health factors like repeated urinary tract infections, protein in urine, pelvic inflammatory disease. There is a poor response to treatments by the patient if he has hypothyroidism (Belen E, 2015).

Due to hypothyroidism weight can increase or due to overweight person can have the disease. There may be other conditions of the gland like swelling of the gland known as Goiter, inflammation of the gland called thyroiditis, thyroid cancer, thyroid storm, thyroid nodule, etc. (Parangi and Phitayakorn, 2011). Each patient may have any of these symptoms as the main complaint. Different people suffer from different symptoms and problems.

Hypothyroidism is an elusive one. Symptoms are undeniable sometimes. The patient underwent tests for hypothyroidism detection. TSH is measured by RIA (radioimmunoassay). Normally, low level of TSH is enough for normal functioning of the gland. When the gland is insufficient TSH level becomes increased. In some cases the T4 and T3 level can be in normal range. Rise in TSH represent failure in thyroid gland. The patient was checked for his TSH level with a blood test. The result gave TSH level of 5.0 milli-international units per liter (mIU/L). The reference range of TSH normal functioning is 0.4 – 4.0 milli-international units per liter (mIU/L) (Updated by: Brent Wisse, 2015). The reference range of T4 in blood is 4.5 to 11.2 mcg/dL (micrograms per deciliter) (Updated by: Brent Wisse, 2015). The T4 level in the patient was found to be 2.7 mcg/dL. It indicated that the patient was suffering from primary hypothyroidism.  Due to primary hypothyroidism T4 is decreased and TSH is increased. In case of secondary hypothyroidism T4 is decreased and the TSH is decreased or normal (I Kostoglou-Athanassiou, 2010). Thyroid stimulating hormone assays are most useful test for functioning of thyroid.

Patient Demographics

TSH test alone can be misleading in some patients (DS, 2015). T3 level was tested. Low level of total T3 means the patient may have hypothyroidism condition. The reference range is 100 to 200 ng/dL (Updated by: Brent Wisse, 2015). The patient had T3 level of 27.8 ng/dL. This indicated that the patient had hypothyroidism. There was no Thyroid peroxidise antibody found from tests. Presence of this antibody in blood suggests that cause of disease is an autoimmune problem. Thyrotropin releasing hormone (TRH) test was done. After TRH administration in blood there was increase in TSH level. It suggested that the cause for hypothyroidism was because of the gland not secreting the hormone. Patients who show greater response to TRH have chances of having hypothyroidism (Doi et al., 2007). A thyroid scan was done. It was done in the radiology department. The patient had to take a pill that had iodine. He was then asked to wait for 4 hours. Throughput this time he had to lie under a camera and pictures were taken which correlated amount of iodine taken up. This was done by measuring the intensity of gamma rays emitted by radioactive iodine. A second scan was done after 24 hours. It is called radioactive iodine uptake test (RAIU) (Westphal JG, 2015). It revealed that the gland was swollen. Serum thyroid binding globulin test was done on the patient. This test is done to measure level of protein that is moving thyroid hormone in body. The test was done by collecting blood sample. It is then examined by electrophoresis. The reference value is 1.3 to 2.0 mg/100 mL for electrophoresis (Updated by: Brent Wisse, 2015). The result was found to be 4.6 mg/100 mL. It indicated that the patient had hypothyroidism.

Ultrasound test was done to detect nodules. This test tells about whether the nodule found is solid or fluid-filled. But it does not say whether a nodule is benign or malignant.  No nodules were found. No biopsy was done as nodule was not found. Thyroid biopsy is usually done to find the cause of nodule in thyroid gland that means whether it is cancerous or benign (Liu X, 2015).

The sign and symptoms also suggested that the patient was suffering from the disease. He was feeling tired all the time and had discomfort in neck. Increased sensitivity to cold, constipation, dry skin, muscle weakness indicated that he was suffering from hypothyroidism. He had elevated blood cholesterol level of 250 mg/dL whereas the normal reference range is 180 to 200 mg/dL (Updated by: Michael A. Chen, 2015). He was overweight at 94 kg. Being overweight is an indication that the person may be having hypothyroid condition.

Signs and Symptoms of the Disease

If hypothyroidism disease is left untreated, it can progress and the symptoms can get worse. Further problems in woman can cause high cholesterol, infertility, etc. severe condition can sometimes lead to seizures, heart failures, coma and death.

This disease can be treated well. A daily, single tablet of the medicine Levothyroxine is used to treat the disease. The T4 thyroid hormone is contained in it. This is known as thyroid replacement treatment. It brings the T4 back to normal amount that the body cannot make. The patient needs to take that for the rest of her life.  This medication is dependent on factors like weight, age, severity, and other health problems. Other medications include Placebo.

Conclusion:

Hypothyroidism is a disease of much concern. The sign and symptoms are many, causing a lot of problems to the patient. If a person has hypothyroidism, it can be detected by the various tests. Proper detection is necessary because this disease is of much concern. A number of tests are there for detection. Proper medication is needed. Levothyroxine can thus be used to treat the present case.

References:

Doi, S., Issac, D., Abalkhail, S., Al-Qudhaiby, M., Hafez, M. and Al-Shoumer, K. (2007). TRH Stimulation When Basal TSH is Within the Normal Range: Is There “Sub-Biochemical” Hypothyroidism?. Clinical Medicine & Research, 5(3), pp.145-148.

DS, R. (2015). Serum thyroid-stimulating hormone measurement for assessment of thyroid function and disease. Endocrinol Metab Clin North Am., 30(2), pp. 245-64.

Friedman, T., Scherer, W. and Friedman, T. (2012). The everything guide to thyroid disease. Avon, Mass.: Adams Media, pp. 11.

I Kostoglou-Athanassiou, K. (2010). Hypothyroidism – new aspects of an old disease. Hippokratia, [online] 14(2), p.82. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895281/ [Accessed 28 Jun. 2015].

Nlm.nih.gov, (2015). Thyroid Diseases: MedlinePlus. [online] Available at: https://www.nlm.nih.gov/medlineplus/thyroiddiseases.html [Accessed 21 Jun. 2015].

Parangi, S. and Phitayakorn, R. (2011). Thyroid disease. Santa Barbara, Calif.: Greenwood, pp. 22.

Phitayakorn, R. (2010). Thyroid Disease, ABC-CLIO, pp. 23-24.

Thyroid Health and the Environment. (2007). Thyroid, 17(9), pp.807-809.

Updated by: Brent Wisse, a. (2015). T3 test: MedlinePlus Medical Encyclopedia. [online] Nlm.nih.gov. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/003687.htm [Accessed 26 Jun. 2015].

Updated by: Brent Wisse, a. (2015). TBG – blood test: MedlinePlus Medical Encyclopedia. [online] Nlm.nih.gov. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/003374.htm [Accessed 27 Jun. 2015].

Updated by: Brent Wisse, a. (2015). TSH test: MedlinePlus Medical Encyclopedia. [online] Nlm.nih.gov. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/003684.htm [Accessed 23 Jun. 2015].

Updated by: Michael A. Chen, a. (2015). Cholesterol testing and results: MedlinePlus Medical Encyclopedia. [online] Nlm.nih.gov. Available at: https://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000386.htm [Accessed 25 Jun. 2015].

Ward, C. (2007). The thyroid. Philadelphia: Saunders , pp. 5.

Belen E, DeÄŸirmencioÄŸlu A, Zencirci E, Tipi FF, Altun Ö, KarakuÅŸ G, Helvacı A, Zencirci AE,KalaycıoÄŸlu E (2015)  The Association between Subclinical Hypothyroidism and Epicardial Adipose Tissue Thickness Korean Circ J., 45(3), pp. 210.

Westphal JG, Winkens T, Kühnel C, Freesmeyer M. (2014)  Low-activity (124)I-PET/low-dose CT versus (131)I probe measurements in pretherapy assessment of radioiodine uptake in benign thyroid diseases, J Clin Endocrinol Metab,  99(6), pp. 2138-45.

Liu X, Zhu L, Wang Z, Cui D, Chen H, Wei L, Wu Y, Rong R, Wu Y, Yao Q, Zhang Z, Cibas ES,Alexander EK, Yang T. (2015), Comparison of two different standards of care in detecting malignantthyroid nodules using thyroid fine-needle aspiration, Mol Clin Oncol. , 3(3), pp. 682-686.