ecdocrine

Subjective Reason for visit by patient A female patient aged 48 years old reports to the outpatient clinic that she suffers from persistent fatigue. She says that the problem has persisted for several months. She further says that she also feels depressed and has concentration difficulties. She is further investigated and reveals that she has been constipating over the past couple of months. She reports that she has noticed an increase in her body weight although she has experienced a loss of appetite.

The woman says that she has developed brittle hair and her skin has become significantly dry. The lady who is a housewife and lives with her husband and two children does not have any medical history worth noting.

The initial physical exam shows the normal important signs, has no swelling in the face, her tongue is normal, her skin moist enough, her eyebrows aren’t thinned out, the eyelids have not thickened either, does not exhibit perorbital swelling, no neck thickening has no unusual cardiovascular activity, no unusual pulsations and no goiter either. Review of Systems The review of the system showed non-contributory, with physical exam outcome showing typical trends.

It incorporated the vital pulse rate signs, pressure of blood and blood mass index and signals of hypothyroidism such as enlarged thyroid gland, ankle jerk relaxation period delayed, dry skin, hypothyroid face, frontal hair recession, myopathy, effusions and cerebellar signs (El-Shafie, 2003). Objective DIAGNOSIS Hypothyroidism Hypothyroidism is primarily caused by thyroid function failure and insufficient thyroid stimulating hormone release from the pituitary gland or TRH released from the hypothalamus. It is possible to differentiate secondary hypothyroidism in hypothalamic and pituitary by use of the TRH test.

In some instances, the failure of the action of the hormone in the tissues on the periphery can be observed. Hypothyroidism at primary level can be clinical where T4 is reduced and TSH increased in turn. It may also be subclinical where in which TSH is increased while FT4 in normal. FT4 is reduced in secondary hypothyroidism while TSH in reduced or normal (Athanassiou & Ntalles, 2010). The most common cause of primary hypothyroidism is chronic autoimmune thyroiditis. Radioiodine treatment and thyroidectomy are some of the less common causes.

Iodination of salt, routinely done in many countries, could increase the occurrence of overt hypothyroidism. The occurrence of clinical hypothyroidism is 0.5 -1.9 % among women and less than 1% in men. The subclinical figures are 3 to 13% among women and 0.75% in men (Athanassiou & Ntalles, 2010). It is important to distinguish between subclinical hypothyroidism and clinical hypothyroidism. Clinical signs are more pronounced and serious. Some patients may even slip into a coma. Subclinical symptoms are much less and less severe (Athanassiou & Ntalles, 2010).

Assessment Pathophysiology Hypothyroidim is an endocrine disorder condition that can be treated easily using thyroid replacement therapy. The dosrder has been noted to persist in some patients despite having been subjected to levothyroxine. In such a setting, it is of importance that the possibility of gastrointestinal malabsorption, pancreatic disease, nephrotic syndrome, heart disease, liver disease, absorption interference of other drugs or pregnancy (Wilder, Bravenboar, Herremans, Vanderbruggen, & Velkeniers, 2017). T3 and T4 are secreted from the thyroid gland.

While T4 is exclusively produced in the thyroid glands, T3 is secreted from the deiodination in extrathyroidal T4 tissue. The deficiency of T3 is responsible for the biochemical and clinical showing of hypothyroidism. Consequently, a basic function such as the consumption of oxygen by the mitochondria and the calorigenesis is delayed.

The reduction in the metabolism of energy and the production of heat is manifest in the low rate of basal metabolism, reduced appetite and, intolerance to cold and a marginally lower basal temperature level of the body (Athanassiou & Ntalles, 2010). Differential Diagnosis Chronic fatigue syndrome CFS, which is the shorthand for chronic fatigue syndrome, is a common health condition that constitutes physical and mental fatigue. It is usually diagnosed after excluding medical triggers.

It has been suggested, in the recent time, that the condition should be renamed as Syndrome Exertional Intolerance Disease (Abdulla & Torpy, 2017). It is evident then that the diagnosis of CFS is syndromic. The presence of CFS cannot be confirmed by any clinical test. The treatment of CFS is supportive. Thus, there is no specified effective therapy that generates reproductive outcomes. CFS treatment is anchored on a host of symptoms in which fatigue and the signs of post exertional malaise are conspicuous; some definitions describe them.

It is urgent to conduct a thorough clinical examination and sieves out any alternative diagnoses, which may need specified treatment, of psychiatric nature. For instance, it is of essence to distinguish between weakness and fatigue. Weakness may be an indication of a neuromuscular problem including anhedonia, which suggests serious depression (Abdulla & Torpy, 2017). Addison's disease Addisons disease is not a common disorder. It is a rare disorder of the endocrine functions. The ailment affects both males and females in equal measure (Sarkar, Sarkar, Ghosh & Bandyopadhyay, 2012).

Addison’s disease syndrome starts slowly with fatigue growing worse, general weakness, loss of weight, hypotension and a loss of appetite. Hypoadrenocorticism clinical signs do not start showing until a large percentage (90%) of the grandular tissue has been decimated. There is hyperpigmentation (bronzing) of skin. The bronzing is more conspicuous on skin that has been exposed to the sun and at points where there is pressure, including knees and elbows. These are triggered by high levels of adrenocorticotrophic hormone or beta-lipotropin.

The production of melanocyte can be triggered by any of the two mentioned hormones (Sarkar, Sarkar, Ghosh & Bandyopadhyay, 2012). The progression of Addison’s disease develops gradually; and thus makes it easy to ignore them. An occurrence of an accident or incidence of a disease could lead to a crisis. Addisonian crisis is marked by abrupt deep pain in the lower part of the back, the legs and the abdomen.

Diarrhea and vomiting are also common symptoms, and are commonly followed by dehydration, losing consciousness and low blood pressure periods (Sarkar, Sarkar, Ghosh & Bandyopadhyay, 2012). Plan Diagnostics Hypothyroidism diagnosis is derived from the history, the lab measurements and the clinical outlook. Symptoms occurrence depends on how severe the condition is. It is linked to the level of alteration in biochemical exams. The manifestations are mild at the beginning and could be distinguished with difficulty from the ones that uthyroid patients manifest. They may become severe with time.

In one of the studies, it was noted that a mere 30% of the patients diagnosed with hypothyroid indicated the some of the signs; with 17% of patients with euthyroid manifesting at least one of the symptoms (Athanassiou & Ntalles, 2010). Symptom evaluation is done either when they are still fresh or aggravation of manifest symptoms is clearly noticeable. Usually, there is a question as to whether increasing one’s body weight is linked to the occurrence of hypothyroidism.

The symptom should be evaluated based on the assumption of a slight body weight increase at the range of 3 to 6 kgs and not a major gain in one’s weight and that other co-existing symptoms suffice (Kezunovic & Cojic, 2017). Therapeutic plan The therapy of hypothyroidism is done along with administering thyroxine. It undergoes an 80% transformation to T3 in peripheral issues. The daily thyroxine dose in the substitution initiation therapy depends on several factors, including age, body weight and the incidence of coronary artery ailment and cardiac arrhythmias.

The dose in adults is about 1.8 µg /kg in body weight and increased in young children and neonates, and decreased in the elderly with 3.8 µg/kg and 0.5.