[Solved] A 28-year-old Falls Hypothyroidism Case Study

1. Hypothyroidism: Hypothyroidism is characterized by tiredness and weight gain (Trifanescu & Poiana, 2019).
2. Cushing’s syndrome: Cushing’s syndrome is characterized by hypercortisolism, which results in fast weight gain and moon facies but often results in sleeplessness rather than increased tiredness. An increased cortisol production characterizes by the adrenal glands due to excess ACTH secretion. This causes central obesity, hypertension, hyperglycemia, osteoporosis, skin and muscle atrophy, and depression, among other things(Ciato et al., 2016). Cushing’s disease may intensify depression, resulting in this patient sleeping more than usual.
3. Depressive disorder: The patient may be experiencing an aggravation of depression, but I would first rule out medical explanations for the symptoms.
4. Vitamin B deficiency: Vitamin B deficiency may also contribute to fatigue; however, this condition is not often associated with weight gain.
5. Anemia: Decreased hemoglobin levels might manifest as fatigue. Although weight gain is not a feature of anemia, it would be prudent to rule it out.

 Laboratory tests

• Thyroid function tests will help rule out any thyroid hormone disorder in hypothyroidism. It involves TSH, T3 and T4 levels (Trifanescu & Poiana, 2019).
• Complete anemia panel, which includes Iron w/TIBC, Transferrin, Ferritin, Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), Vitamin B12, Folic Acid and Hemoglobin Solubility.
• Cortisol levels to rule out Cushing’s syndrome(Ciato et al., 2016).
•  Vitamin B levels to rule out any deficiency.

Treatment strategy

• The optimal final treatment approach would be highly dependent on test results. However, other supporting treatments include keeping a sleep diary, adhering to a healthy diet, and documenting this.
• Hypothyroidism is the most probable diagnosis. In this scenario, levothyroxine or Synthroid enhances thyroid hormone levels (Trifanescu & Poiana, 2019). The patient’s thyroid hormone levels must be monitored monthly during routine clinic visits until therapeutic levels are attained.

Inferring from the differentials:

• If the patient is anemic, he or she will need a hematinic depending on the deficiency, such as iron and B12. If the patient has elevated cortisol levels due to Cushing’s disease, somatostatin can be used to treat this disorder(Ciato et al., 2016). I will probably refer the patient to an endocrinologist.
• Supplemental vitamins will also be beneficial in addressing Vitamin B deficiency.

Chronic Illness Responses

Response 1

I appreciate your identification of hypothyroidism as a potential diagnosis for the patient. The patient presented with fatigue, increased sleeping, and weight gain. She also admits having several encounters with depression, which indicates a possibility for the presence of hypothyroidism. You identify that the condition is characterized by tiredness and weight gain. According to Taylor et al. (2018), hypothyroidism results from a decline in the capacity of thyroid glands to produce the required quantities of hormones responsible for regulating body metabolism. Based on available clinical presentations, you also identify Cushing’s syndrome as a potential diagnosis. You assert that the condition is characterized by hypercortisolism, which results in fast weight gain and moon facies but often results in sleeplessness rather than increased tiredness. However, the patient’s symptoms are insufficient to necessitate consideration of Cushing’s syndrome as a differential diagnosis. For instance, pink or purple stretch marks on the skin constitute a common symptom of Cushing’s syndrome (Salma, 2019). However, the patient does not present any skin conditions. Therefore, Cushing’s syndrome should be ruled out.

Response 2

You present useful insight regarding the effectiveness of a thyroid function test in detecting the presence of hypothyroidism. Such a diagnostic procedure detects the levels of thyroid-stimulating hormone and thyroxine in the blood to detect any irregularities in thyroid function (Palui et al., 2019). Therefore, it constitutes a useful diagnostic method to confirm the presence of hypothyroidism. You recommend an administration of levothyroxine or Synthroid to enhance the patient’s thyroid hormone levels. Levothyroxine provides the thyroid hormone that a patient’s thyroid gland would produce if it were working normally, making it an efficient intervention to alleviate hypothyroidism (Trimboli et al., 2020). You present useful insight regarding the available interventions that could help to alleviate the patient’s symptoms.

References

Ciato, D., Mumbach, A. G., Paez-Pereda, M., & Stalla, G. K. (2016). Currently used and investigational drugs for Cushing s disease. Expert opinion on investigational drugs, 26(1), 75-84. https://doi.org/10.1080/13543784.2017.1266338

Palui, R., Sahoo, J., Kamalanathan, S., Kar, S. S., Sridharan, K., Durgia, H., Raj. H., & Patil, M. (2019). Effect of metformin on thyroid function tests in patients with subclinical hypothyroidism: an open-label randomized controlled trial. Journal of Endocrinological Investigation, 42(12), 1451-1458. https://doi.org/10.1007/s40618-019-01059-w

Salma, S. (2019). Case report on steroid-induced Cushing syndrome. Journal of Drug Delivery and Therapeutics, 9(4-s), 598-600. http://dx.doi.org/10.22270/jddt.v9i4-s.3269

Taylor, P. N., Albrecht, D., Scholz, A., Gutierrez-Buey, G., Lazarus, J. H., Dayan, C. M., & Okosieme, O. E. (2018). Global epidemiology of hyperthyroidism and hypothyroidism. Nature Reviews Endocrinology, 14(5), 301-316. https://doi.org/10.1038/nrendo.2018.18

Trimboli, P., Scappaticcio, L., De Bellis, A., Maiorino, M. I., Knappe, L., Esposito, K., Bellastella, G., & Giovanella, L. (2020). Different formulations of levothyroxine for treating hypothyroidism: a real-life study. International Journal of Endocrinology, 2020, 1-5. https://doi.org/10.1007/s40618-019-01059-w

Trifanescu, R. A., & Poiana, C. (2019). Diagnosis and Management of Hypothyroidism in Adults. In Advanced Practice in Endocrinology Nursing (pp. 581-592). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-319-99817-6_30