Running head: HYPOTHYROIDISM

Hypothyroidism Case Study

Gabriela Valdivia

November 1, 2019

GNRS 516 Z1

Azusa Pacific University

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Patient Case Question 1. Clinical symptoms are subjective manifestations of disease that may
only be conveyed by the patient. List a minimum of 6 symptoms that this patient has conveyed
that are consistent with a diagnosis of hypothyroid disease.

Symptoms that are consistent with a diagnosis of hypothyroidism are:

a. tiredness;

b. weakness;

c. multiple aches;

d. cold all the time;

e. recurrent headaches;

f. mild constipation;

g. amenorrhea (i.e., absence of menstruation);

h. difficulty hearing; and

i. difficulty comprehending.

Patient Case Question 2. Clinical signs are objective manifestations of disease that may be
observed or measured by someone other than the patient, often a nurse or primary care provider.
List a minimum of 5 signs that this patient demonstrates that are consis- tent with a diagnosis of
hypothyroidism.

Signs that are consistent with a diagnosis of hypothyroidism are:

a. weight gain;

b. slow and deliberate speech;

c. hoarseness;

d. swollen hands;

e. puffy face;

f. dry and flaky skin; and

g. slow heart rate.

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Patient Case Question 3. Explain the pathophysiology underlying the patient’s abnormal ESR.

The patients elevated ESR indicates inflammation. The thyroid is enlarged and inflamed.

Patient Case Question 4. Explain the pathophysiology underlying the patient’s swollen hands
and puffy face.

Myxedema occurs due to the accumulation of hydrophilic mucopolysaccharides in the

dermis or other tissues. These deposits of chains of sugar molecules (complex
mucopolysaccharides) in the skin attract water, which lead to swelling. These skin
changes are a result of hypothyroidism.

Patient Case Question 5. Explain the pathophysiology behind the patient’s abnormal heart rate.

Insufficient thyroid hormone slows the heart rate. Thyroid hormones regulate the beta-
adrenergic system in cardiomyocytes. Hypothyroidism is associated with decreased
cardiac output due to impaired relaxation of vascular smooth muscle and decreased
availability of endothelial nitric oxide. This produces a cascade effect of increased
arterial stiffness that leads to increased systemic vascular resistance. On a molecular
level, these alterations result from reduced expression of sarcoplasmic reticulum Ca2+-
ATPase and increased expression of phospholamban, which inhibits ATPase.

Patient Case Question 6. List six blood laboratory test results that are lower than normal but
consistent with a diagnosis of hypothyroid disease.
• Serum sodium concentration,
• red blood cell count,
• hematocrit,
• and serum total thyroxine (T4), free thyroxine (FT4), and total triiodothyronine (T3)
concentrations are abnormally low and consistent with a diagnosis of hypothyroid
disease.
• Low serum T4, FT4, and T3 concentrations are definitive for hypothyroid disease.

Patient Case Question 7. Based on the laboratory blood test results in Table 59.1, does this
patient have primary or secondary hypothyroid disease? Explain why. Primary hypothyroidism
because TSH is high, and the patient has Low serum T4, FT4, and T3 concentrations suggesting
that the thyroid is the problem because there is a decreased hormone production by the thyroid
gland. Suppurative or bacterial thyroiditis is a potential cause of hypothyroid disease in this
patient, because the patient’s erythrocyte sedimentation rate, white blood cell count, and body
temperature were all higher than normal.
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Patient Case Question 8. Why might the patient’s serum Ca+2 concentration be abnormal?

The other hormone that the thyroid makes is called calcitonin. This helps to control the levels of
calcium and phosphorus in the blood. The patient’s blood test shows no calcitonin is being
produced by the thyroid.

Patient Case Question 9. Why was Hashimoto thyroiditis excluded as the cause of
hypothyroidism in this patient?

The majority of patients with Hashimoto's have antibodies to thyroglobulin and thyroid
peroxidase. These antibodies cause destruction of thyroid cells which leads to fewer cells
making thyroid hormone. This patient was negative for thyroglobulin and thyroid
peroxidase.

Patient Case Question 10. A diagnosis of hypothyroid disease, possibly the result of
suppurative (i.e., bacterial) thyroiditis, was established. Based upon which information was this
diagnosis made?

• Suppurative or bacterial thyroiditis is a potential cause of hypothyroid disease in this

patient, because the patient’s erythrocyte sedimentation rate, white blood cell count, and
body temperature were all higher than normal.
• The elevated lymphocyte fraction in the white blood cell differential suggests that the
infection has become chronic (i.e., lymphocytes are the primary white blood cell type in a
chronic bacterial infection).

Patient Case Question 11. What is the significance of the patient’s medical history with respect
to levothyroxine use?

Patient recently gave birth and her circulating estrogen levels are increased; the
levothyroxine dose needs to be increase until her estrogen levels become normalize.
Estrogen raises the circulating levels of thyroxine-binding globulin (TBG), thereby increasing
the bound fraction and decreasing the free (bioactive) fraction of circulating thyroxine

Patient Case Question 12. Why is this patient’s abnormal serum cholesterol level consistent
with hypothyroid disease?

A hypothyroid state results in decreased expression of hepatic LDL receptors and reduced
activity of cholesterol-α-monooxygenase, which breaks down cholesterol, resulting in
decreased LDL clearance.
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References

Brueyere, H. (2010). 100 Case Studies in Pathophysiology. Lippincott, Williams, & Wilkins.

Papadakis, M. A., McPhee, S. J. (2019). Current Medical Diagnosis & Treatment (58 Edition)
th
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McGraw-Hill medical