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Homework answers / question archive / NU 621 Unit 3 Discussion-Hypothyroidism Read the following case study and answer the posed questions: Case #1: History: A 65 year old housewife complains of progressive weight gain of 40 pounds in 1 year, fatigue, dizziness, sluggish memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance
Read the following case study and answer the posed questions:
Case #1:
History: A 65 year old housewife complains of progressive weight gain of 40 pounds in 1 year, fatigue, dizziness, sluggish memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.
Physical examination: Vital signs: temperature 96.4oF, pulse 68/minute and regular, BP 108/60, weight 170 lbs, height 5 feet, puffy face, pale, cool, dry skin. The thyroid gland is not palpable, deep tendon reflex time is delayed.
Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.4 ug/dl (N=4.5-12.5), the serum TSH is .9 uU/ml (N=0.2-3.5), and the serum cholesterol is 275 mg/dl (N<200).
Case #2:
J.R. is a 58-year old man who presented with a 6-week history of polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed on day of his visit and was 359 mg/dl. The patient denied any symptoms of numbness, tingling in hands or feet, dysuria, chest pain, cough or fevers. He had no prior history of diabetes and no family history of diabetes.
Admission non-fasting serum glucose 268 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-6.1%). Electrolytes, BUN and creatinine were normal. Physical examination revealed weight of 190 pounds, height 5'6.5" . The rest of the examination was unremarkable, i.e., no signs of retinopathy or neuropathy.
Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please review the rubric to ensure that your response meets the criteria.
NU 621 Unit 3 Discussion-Hypothyroidism
Case Study #1
What is the likely diagnosis, and what symptoms made you consider that diagnosis?
Hypothyroidism is the most probable condition to be found in this patient. The severity of hypothyroidism's effects on the body's various systems is directly proportional to the degree of thyroxine shortage (McCance & Huether, 2019). Cold sensitivity, drowsiness, exhaustion, and a slightly lower body temperature are all symptoms of hypothermia (McCance & Huether, 2019). Hypothyroidism manifests itself in a variety of ways in her case. Hypothyroidism may cause dizziness, poor memory, and sluggish speaking. Weight gain and diarrhea are two of the most frequent gastrointestinal complaints. A sign of musculoskeletal problems is a slowed deep tendon reflex. She may have myxedema since her face is bloated. The integumentary system is associated with pale, cold, and dry skin. A reduction in body temperature and a deepening of her voice, maybe due to hoarseness, are other symptoms of her cold sensitivity (McCance & Huether, 2019).
Which lab data supported the diagnosis?
Because the usual T4 range is (4.5-12.5), a diagnosis might be made based on test results and clinical signs and symptoms.
Explain-Hypothalamic-Pituitary-Thyroid axis and interrelationship
The hypothalamic-pituitary axis is the structural and functional underpinning for neuroendocrine system integration (McCance & Huether, 2019). When the HPA is activated, it releases or inhibits several hormones that affect many bodily processes (McCance & Huether, 2019). The hypothalamus, pituitary, and thyroid glands make up the HPA. In order to induce the release of thyroid-stimulating hormone (TSH), the anterior pituitary creates TRH (TSH). TRH enters the hypothalamic-pituitary portal system and travels to the anterior pituitary to induce TSH production. Temperature and stress may cause a rise in TRH levels, as can reduce T4 levels (McCance & Huether, 2019). Because the increase in TH levels inhibits the HPA, the production and secretion of the hormone are also inhibited.
Case #2
What are the blurred vision mechanisms that were part of his initial symptoms?
The eye's water balance varies because of high blood glucose levels, resulting in blurry vision (McCance & Huether, 2019). Damage to retinal blood vessels and red blood cells, platelet aggregation, hypoxemia, and hypertension are all contributing factors in diabetic retinopathy. The cellular glucose intake cannot be regulated by blood vessels, eye lenses, or neurons. Intracellular glucose is diverted into a different metabolic route in hyperglycemia, according to McCance & Huether (2019). The polyol route is the name given to this process. When the polyol pathway is overactive, the enzyme aldose reductase builds up excessive sorbitol. For example, water is drawn into the tissue when sorbitol builds up within cells. Sorbitol destroys Schwann cells and interferes with nerve transmission by interfering with the ion pumps in the nerves. This persistent neuroinflammation causes retinal sensory cells to be damaged, leading to vision loss. Inflammatory cells are activated, and inflammatory mediators are released as a result.
Are there correlations between his abnormal blood chemistries and his other symptoms?
High blood sugar levels are indicated by a fasting blood sugar of 268 mg/dl and an HbA1c of 9.6%. Polyuria, polydipsia, and polyphagia are all symptoms of high blood sugar. Hyperglycemia causes osmotic diuresis, which causes polyuria and dehydration (McCance & Huether, 2019). As a result, a substantial quantity of glucose is expelled in the urine since the individual's renal threshold is exceeded by the plasma glucose level.
Identify the cardiovascular and microvascular risk factors in this patient's history, physical examination, and laboratory data.
Retinopathy is the most likely microvascular complication for this patient. According to his blood test, he complained of hazy vision and high blood sugar. Therefore, this is likely connected. Diabetes is associated with an increased risk of hypertension. Microalbuminuria is the underlying cause of diabetes mellitus type 1 (DM1). In type 2 diabetes, metabolic syndrome is a contributing factor in the development of hypertension (McCance & Huether, 2019). Coronary artery disease and stroke are more likely in those with high blood pressure. Oxidative stress and proinflammatory agents that cause cardiac remodeling and cardiomyopathy with increasing quantities of collagen in the ventricular wall and ventricular hypertrophy may be linked to an increased risk of congestive heart failure.
Additionally, atherosclerosis has several risk factors for diabetes. The development of atherosclerosis may be exacerbated by insulin resistance, hyperglycemia and hypertriglyceridemia, low HDL, high LDL, lipoprotein oxidation, and atypical platelets (McCance & Huether, 2019). Inflammation, oxidative stress, endothelium and vascular smooth muscle dysfunction and thrombosis are all promoted by the binding of glycosylated end products to their receptor (RAGE) in the blood vessel walls.
Reference
McCance, K. L., & Huether, S. E., (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier Saunders.
