Marty Miller, age 26, who is training to run her fifth marathon, has gradually increasing dyspnea...

Marty Miller, age 26, who is training to run her fifth marathon, has gradually increasing dyspnea on exertion, fatigue, and weight gain. She has no children and is not now pregnant. Her nurse practitioner suspects a thyroid hormone disorder.

Instructions: Answer the following questions about Marty’s pathophysiology:

What are other symptoms about which you should ask Marty? Why?
If Marty has developed hypothyroidism, what might be found on examination?
The nurse practitioner drew blood to measure Marty’s TSH levels. What gland secretes TSH?
If Marty has hypothyroidism, what do you expect the TSH results to be? Why?
Marty is started on thyroid replacement therapy. Why should you teach her the signs and symptoms of hyperthyroidism as well as those of hypothyroidism?
What should Marty be taught to ensure adequate absorption of levothyroixine?
When her thyroid disorder was undiagnosed, was Marty at risk for thyroid storm? Why, or why not?

Expert Solution

The other symptoms that should be asked to the patient includes:

Lethargy
feeling cold despite warm ambient temperature and intolerance to cold climate
hair loss or dryness
Brittle nails,
constipation,
dry skin,
enlarged thyroid gland causing symptoms like dyspnea, dysphagia, inability to lie down
Hypercholesterolemia
Menstrual abnormalities
sexual dysfunction
Sluggishness,
weight gain

The examination in hypothyroid patient may reveal enlarged thyroid gland ( goiter), bradycardia, high BMI, hump on back of neck, myxedema etc

TSH is secreted by the Pituitary gland.

In hypothyroid patients, the TSH will be elevated. This is because TSH is secreted as a response to low circulating levels of the thyroid hormone. TSH is secreted to stimulate thyroid growth to produce more hormone.

A patient on levothyroxine may experience symptoms of hyperthyroidism as a result of medication. If the medication does not result in adequate blood levels of thyroid hormone, then the patient can experience symptoms of hypothyroidism and may need escalation of dose. Hence, both symptoms of hypothyroidism as well as hyperthyroidism should be taught.

Thyroxine tablets should be taken in empty stomach to ensure adequate absorption. A delay of 1 hour before food intake is recommended by most doctors.

The patient here was not at risk of thyroid storm because she has a deficit of thyroid hormone and not an excess.

Nightingale answered 3 months ago

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