Endocrine Case Study of Shirley, 50-year-Old Housewife Diagnosed with Hypothyroidism – Best Assignment Solutions(2022)

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Endocrine Case Study

Shirley, a 50 year old housewife, comes in complaining of progressive weight gain of 20lbs over the last year, fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance. She is concerned and wants labs to further evaluate her condition.

PMH: Anxiety disorder diagnosed 1 year ago

Meds: alprazolam .5 every 6 hours as needed for anxiety

Allergies: None

ROS: Negative except as listed above

…

Solution

Endocrine Case Study of Shirley, 50-year-Old Housewife Diagnosed with Hypothyroidism

Background to the Case Study

Shirley is a 50-year-old housewife who presents at the clinic with the chief complaint of progressive weight gain over the last 12 months, fatigue, and postural dizziness. Additional symptoms include memory loss, slow speech, deepening voice, and cold intolerance, amongst others.

Her PMH indicated Anxiety disorder a year ago, is currently on alprazolam medication for the anxiety with no known allergies. Other than the stated symptoms, her ROS reports negative while a physical exam indicates an obese female, while lab results determine the patient has hypothyroidism. This essay explains the action of thyroid hormone and how it affects Shirley’s diagnosis, together with the role of Thyroxine (T4) and triiodothyronine (T3) in the body.

The action of Thyroid Hormone and how it Impacts the Diagnosis

THs have been determined to control energy metabolism across ages, meaning that patients with a dysfunction of TH exhibit clinical symptoms of metabolic dysregulation like changes in their weight reported by Shirley over the last 12 months. In the case of hypothyroidism. THs trigger a hypo- metabolic state whose identifying symptoms are decreased energy expenditure, raised cholesterol levels, lowered lipolysis, and gluconeogenesis accompanied by weight gain.

TH is a critical factor in the regulation of mitochondria respiration as well as biogenesis. It is worth noting that the TH intracellular regulation’s metabolic impact in different tissues ranges from the liver to the pancreas, the hypothalamus, and skeletal muscles, to mention but a few(Cicatiello et al., 2018).

For example, in the liver, lipid homeostasis is controlled by the local T3 levels, impacting the individual’s susceptibility to liver steatosis and obesity. Additionally, in the hypothalamus, the TH local availability controls feeding behavior and, by extension, the energy expenditure.

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Increased Thyroid Stimulation Hormone Levels Rise and the Negative Feedback Mechanism in the Body

Endocrinologists posit that the thyroid gland is mainly controlled by a feedback mechanism where THs secretion is stimulated by thyrotropin or thyroid-stimulating hormone (TSH) with pituitary thyrotropin secreting them (Fitzgerald & Bean, 2018). Studies have demonstrated that the axis known as the hypothalamic-pituitary axis- controls the TSH release via hypothalamic neurons that secrete thyroid releasing hormones.

Increased stimulation of thyroxine (T4) secretion at 80% and triiodothyronine or (T3) at 20% has it that when T4 enters into circulation, deiodination occurs, meaning it is converted into T3. After deiodination, T4 and T3 can exert negative feedback on the levels of TSH since high levels of T3/T4 lower the releases of TSH from the anterior pituitary while low levels of T3/T4 increase doe increase the release of TSH.

Roles of Thyroxine (T4) and Triiodothyronine (T3) In the Body

According to Teixiera et al. (2020), the THs actions affect peripheral tissues through varied mechanisms. Take the case of T4 (the thyroid gland’s main product, which is converted into an active home. T4 can then be inactivated by type 3 5 deiodinase (D3). Likewise, T3 can also be inactivated by D3, where either T4 or T3 gain access to the cells through particular membrane transporters. Using canonical pathway or non-canonical signaling pathways and a host of TH receptors and subtypes regulate target genes genes’ transcriptional activity.

Conclusion

In conclusion, deiodination is arguably the most significant TH activation pathway, with peripheral tissue having several pathways capable of modulating TH availability. Therefore drug development to combat TH dysfunctions should focus on deiodinase action aimed at achieving specific metabolic outcomes.

References

Cicatiello, A. G., Di Girolamo, D., & Dentice, M. (2018). Metabolic effects of the intracellular regulation of thyroid hormone: old players, new concepts. Frontiers in endocrinology, 9, 474.

Fitzgerald, S. P., & Bean, N. G. (2018). Thyroid-stimulating hormone (TSH) autoregulation reduces variation in the TSH response to thyroid hormones. Temperature, 5(4), 380-389.

Thyroid-stimulating. S., dos Santos, P. B., & Pazos-Moura, C. C. (2020). The role of thyroid hormone in metabolism and metabolic syndrome. Therapeutic Advances in Endocrinology and Metabolism, 11, 2042018820917869.

Question

Endocrine Case Study

Shirley, a 50 year old housewife, comes in complaining of progressive weight gain of 20lbs over the last year, fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance. She is concerned and wants labs to further evaluate her condition.

PMH: Anxiety disorder diagnosed 1 year agoMeds: alprazolam .5 every 6 hours as needed for anxietyAllergies: NoneROS: Negative except as listed above

Physical Exam:

• General: Obese female
• Vitals: T 98.6F, HR 58/min and regular, BP 110/60.
• Head: Normocephalic
• Eyes: PERRLA, EOMI, puffiness noted around eyes and face
• Neck: Thyroid gland is non-palpable
• Skin/Integument: pale, cool, dry, thick skin

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The provider checks labs and determines Shirley has hypothyroidism.

Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information.

Discussion Questions:

1. Explain the action of thyroid hormone and how this impacts the diagnosis. Your answer should contain the impact of the thyroid hormone on functions in the body.
2. As Thyroid Stimulation Hormone (TSH) levels rise, explain how this impacts the negative-feedback mechanism in the body.
3. What are the roles of Thyroxine (T4) and triiodothyronine (T3) in the body?

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