Case Study

BIO 139 Case Study 1 (25 points total) A 30-year old female demonstrated a subtle onset of the following symptoms: dull facial expression; droopy eyelids; puffiness of the face and periorbital swelling; sparse, dry hair; dry scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 beats/min); a blood pressure of 90/70; anemia (hematocrit = 27); enlarged heart (upon radiological exam); constipation, and hypothermia. Plasma concentrations of total and free T4 and T3 were as follows: T4 T3 Total 3.0 µg/dL 0.14 ng/dL Free 0.6 ng/dL 0.01 ng/dL Radioimmunoassay (RIA) of peripheral blood indicated elevated TSH levels. A TSH stimulation test did not increase the output of thyroid hormones from the thyroid gland. You can cite your text book for your answers but you must cite at least one primary literature article within your case study. Many resources are available to you to help with your case studies (e.g. online resources, books, medical professional you may know); please cite your sources. You must use at least one citation per question. Your answers should be through and detailed (i.e. complete sentences and/or paragraphs focused on the relevant anatomy and physiology). QUESTIONS: 1. (2 pts) What endocrine organ is involved here? Thyroid. What are its major functions. (3pts)? The Thyroid is a butterfly shaped endocrine hormone gland that regulates metabolism and plays a role in growth and development. Info found at: https://www.thyroid.org/hypothyroidism/ 2. (4 pts) Is this a primary or secondary disorder? This is a Primary disorder. Why? (Is a TSH or TRH determination necessary for your diagnosis?) What does this mean? T3 and T4 are low. Information found at https://www.endocrineweb.com. 3. (5 pts) Describe the feedback loop involved (both the normal and abnormal), in detail. The Hypothalamus secretes TRH which stimulates thyrotrophs in the anterior pituitary which releases TSH to stimulate the thyroid releasing then t3 and t4. Info found at https://www.ncbi.nlm.nih.gov/books/NBK499850/ 4. (4 pts) List several defects/agents/conditions that could cause these symptoms. These symptoms could be caused by a host of different possible issues. Only lab tests could rule them out, however some of the things a physician might look at with these symptoms could include, brittle hair could be caused by Cushing's syndrome. Bradycardia may be related to a cardiovascular disorder. Droopy eyelids could be caused by stroke or a condition such as myasthenia gravis. 5. (3 pts) Would you expect to find a palpable goiter? Explain your answer. Yes. With the low levels of T3 and T4 and also an increase in TSH, over stimulation of the thyroid can cuase swelling. https://www.mayoclinic.org/diseases-conditions/goiter/symptoms-causes/syc-20351829 6. (4 pts) Describe a suitable treatment for this individual and give a treatment plan. The pt will need to start medication therapy with synthetic hormones such as Synthroid. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289