Primary hypothyroidism in a 30-year-old male: case analysis

Endocrine System

"A significant proportion of hypothyroid individuals do not have symptoms and this is where screening with a blood test is important.

…Tthe doctor will measure is the blood level of TSH (thyroid stimulating hormone),

which will be high in this situation"

(Hyperthyroidism, N.d., ¶ 5).

Case History

A 30-year-old male demonstrated a subtle onset of the fallowing symptoms:

Dull facial expression;

droopy eyelids;

puffiness of the face and periorbital swelling;

sparse;

dry hair;

dry scaly skin;

evidence of intellectual impairment;

lethargy;

a change of personality;

bradycardia (60 b/min);

a blood pressure of 90/70;

anemia (hematocrit 27);

enlarged heart (upon radiological exam); constipation, and hypothermia.

Plasma concentrations of total and free T4 and T3 follow:

Free, Radioimmunoassay (RIA) of peripheral blood indicates elevated THS levels.

A THS stimulation test did not increase the output of thyroid hormones from the thyroid gland.

Considering the case introduced at this paper's start, the researcher addresses the following considerations:

1. Involved endocrine organ;

2. Whether this disorder is considered a primary disorder or a secondary one along with the rationale for the decision. Whether's a THS or TRH determination is necessary for the researcher's diagnosis;

The feedback loop involved; indicating if there is an increased THS level;

4. A number of defects that could cause the patient's symptoms;

5. Whether one would expect to find a palpable goiter;

6. A recommended suitable treatment for the individual being assessed.

Involved Endocrine Organ

The endocrine system constitutes the body's control system, composed of a collection of glands that produce chemical regulatory substances called hormones to maintain a stable internal environment in the body. According to the Columbia Encyclopedia entry, "Endocrine system" (2008), "The endocrine system includes the:

pituitary gland, thyroid gland, parathyroid glands, adrenal gland, pancreas, ovaries, and testes (see testis ). (Endocrine system, 2008, ¶ 1)

Sometimes, the thymus gland, pineal gland, and kidney are perceived as endocrine organs. The endocrine glands differ from other glands such as sweat glands, salivary glands, and glands of the gastrointestinal system as the hormones they produce secrete directly into the body's internal environment instead of passing through ducts or tubes. Once in the body's internal environment, the system transmits the hormones through the bloodstream or by diffusion to act at remote points in the body. Thyroxine from the thyroid gland, which the researcher asserts to depict the endocrine gland involved in the disorder reported in the case study, affect almost all body cells (Endocrine system, 2008).

In the journal article, "Review of the endocrine system," Deirdre G. Bauer (2005), RN and Charge Nurse, explains that the thyroid gland, located in the neck below the cricoid cartilage, secretes two hormones, vital for energy:

Thyroxine (T4) and triiodothyronine CF3)

Calcitonin, a third hormone the thyroid gland secretes, fuels the uptake of calcium ions from the blood to the bones (Bauer, 2005, Glands section, ¶ 3).

Hypothyroidism, a Secondary Disorder

Hypothyroidism, a Secondary Disorder, requires a THS or TRH determination. Bauer (2005) asserts that the majority of thyroid function disorders relate to hypersecretion (hyperthyroidism) and hyposecretion (hypothyroidism) of thyroid hormones. The researcher asserts that the subtle onset of the symptoms noted at this paper's start indicate the 30-year-old male to be suffering from hypothyroidism, a secondary disorder. Bauer notes that in adults, three common causes of hyperthyroidism consist of: "Grave's disease, toxic multinodular goiter, and toxic adenoma (Plummer's disease). Thyroid storm is an exacerbation of all of the signs and symptoms of hyperthyroidism and is a true medical emergency" (Bauer, 2005, Disorders of… section, ¶ 1).

In hypothyroidism, inadequate or low levels of thyroid hormones materialize. Of the numerous causes, chronic thyroiditis (Hasimoto's thyroiditis) denotes one of the primary ones. "Long-standing hypothyroidism," according to Bauer, "may result in myxedema" (Disorders of… section, ¶ 2). As numerous disorders evolve from hyposecretion or hypersecretion of hormones, albeit, laboratory tests constitute essential tools for diagnosing endocrine disorders.

Diagnostic tests of the endocrine system focus on hormone levels; the interrelationships among the hypothalamus, the anterior pituitary gland, and other endocrine glands; or the substrates controlled by the hormone. Stimulation testing, hormonal suppression testing, and assays, along with 24-hour urines, radiography, CT scanning, MRI, and fine-needle biopsies are examples of diagnostic studies (Bauer, 2005, Diagnostic studies section, ¶ 2).

The thyroid, shaped like a butterfly, is positioned right below the larynx, or Adam's apple; in front of the trachea, or windpipe. The thyroid, which stores iodine the body obtains from food, uses iodine to create the thyroid hormones. "Low thyroid hormone levels can alter weight, appetite, sleep patterns, body temperature, and a variety of other physical, mental, and emotional characteristics" (Sims & Haggerty, 2006, ¶ 3). In the publication, "Hypothyroidism," Judith Sims, M.S. And Maureen Haggerty (2006), assert report that when the thyroid gland fails to produce or secrete as much thyroxine (T4) and triiodothyonine (T3) as the body needs, then hypothyroidism, or underactive thyroid, develops.

As T4 and T3, two vital thyroid hormones "regulate such essential functions as heart rate, digestion, physical growth, and mental development, an insufficient supply of this hormone can slow metabolic processes, damage organs and tissues in every part of the body, and lead to life-threatening complications" (Sims & Haggerty, 2006, ¶ 1). A person may not exhibit symptoms of hypothyroidism, a common chronic diseases in the United States (U.S.), however, until years after his/her thyroid stopped functioning. In addition, a physician may at times mistake hypothyroidism as a sign of a different illness. Sims and Haggerty (2006), explain that the doctor diagnosis hypothyroidism based on the patient's observations, his/her medical history, a thorough physical examination, and by results from thyroid function tests. Physicians specializing in treating thyroid disorders (endocrinologists) will most likely recognize subtle symptoms and physical indications of hypothyroidism. "A diagnostic evaluation may include a blood test known as a thyroid-stimulating hormone (TSH) assay, thyroid nuclear medicine scan, thyroid ultrasound, or needle aspiration biopsy (which is also used to provide information on thyroid masses)" Sims & Haggerty, 2006, Diagnosis section, ¶ 2).

Even though hypothyroidism reportedly affects up to 11 million adults and children, perhaps up to two out of every three individuals with hypothyroidism may not realize they have the disease. Hypothyroidism, merits its nickname "Gland Central" because it influences most every cell, organ and tissue in the human body (Sims & Haggerty, 2006).

The TSH Level Feedback Loop

"Radioimmunoassay" (2008), the title of a recent published medical article, also denotes the highly sensitive laboratory technique RIA, which measures minute amounts of substances in the body. These substances include "antigens, hormones, and drugs present in the body" (Radioimmunoassay, 2008, ¶ 1). During the feedback loop involved to determine if an increased TSH level is present, when the individual performing the test injects the substance or antigen to be measured into an animal, this causes it to produce antibodies. In turn, the individual performing the withdraws the serum containing the antibodies and treats it with a radioactive antigen initially; later with a nonradioactive antigen. The lab personnel then utilize measurements of the amount of radioactivity to determine the amount of antigen present. (Radioimmunoassay, 2008, ¶ 1).

Disease of the pituitary gland (occurs rarely)

disease of the hypothalamus (located about the pituitary), which stimulates the pituitary gland tumor, cyst, or other abnormal structure between the hypothalamus and pituitary gland that prevents the pituitary from receiving the stimulus to secrete TSH. (Sims & Haggerty, Description section, 2006, ¶ 2).

A Palpable Goiter's Presence

The journal article, "Hyperthyroidism" (N.d.), explains that a goiter denotes the enlargement of the thyroid gland. The majority of individuals with a goiter will not likely realize it, until the goiter grows to a visible or palpable size, as a goiter may develop to enormous size prior to producing symptoms of compression. Frequently, a low iodine supply in the diet contributes to the development of a goiter. In areas of the world where dietary iodine is low, doctors note a larger number of patients with goiters. The thyroid gland implements this defense mechanism to maintain balance with the body's need for thyroid hormones

As a goiter may be associated with hyperthyroidism or hypothyroidism, to rule out the abnormal functioning of the thyroid, the doctor orders blood tests. After these tests, the doctor will determines if the need for imaging studies exists. These would include ultrasound, CT scan, and etc. Most patients with goiter do not require any intervention, however are monitored by periodic neck exams and blood work. When the suspicion of thyroid cancer or compression symptoms materialize, albeit, surgery to remove all or part of the goiter may be necessary. When the removal of entire thyroid becomes necessary, the patient requires lifelong thyroid hormone medication (Hyperthyroidism, N.d., Goiter section). For the patient examined by this paper, further testing would be needed for the determination of whether or not one would expect to find a palpable goiter A Suitable Treatment

The journal article, "Hyperthyroidism" (N.d.), also attributes hypothyroidism to the inability of the thyroid gland to produce an adequate amount of thyroid hormones. "Unlike with Grave's disease, the thyroid cells in hypothyroidism face autoimmune destruction, which means that the body directs its immune response against these thyroid cells and destroys them; Hashimoto's disease is another name for this thyroid-cell-destroying process (Hyperthyroidism, N.d., ¶ 4). Symptoms of hypothyroidism include many of those evidenced by the patient examined in this study; noted in the table at the end of this investigation. After confirming the diagnosis of hypothyroidism, the physician will initiate treatments to replace the thyroid hormone. Generally, treatment proves successful with the administration of one daily dose of oral levothyroxine (Synthroid, Levoxyl, etc.). For follow-up, the physician periodically measures the thyroid-stimulating hormone level to guide ongoing treatments (Hyperthyroidism, N.d.).

Table 1 compares the 30-year-old male case patient's symptoms to symptoms of Hypothyroidsm.

Table 1: Comparison of Case Patient's Symptoms to Symptoms of Hypothyroidism (adapted from Assignment; Sims & Haggerty, 2006, Causes and symptoms section, ¶ 8).

30-year-od Male Patient's Symptoms

Symptoms of Hypothyroidism

Dull Facial Expression

Depression

Droopy Eyelids

Swollen eyelids

Puffiness of the face

Progressive Hearing Loss

Periorbital swelling

Weight Gain

Sparse; Dry Hair

Dryness or loss of hair

Dry Scaly Skin

Dry Skin

Intellectual Impairment

Problems with Memory and Concentration

Lethargy

Fatigue

Change of Personality

Numb, tingling hands

Bradycardia (60 b/min)

Decreased Heart Rate

Anemia (hematocrit 27)

Muscle pain or weakness

Enlarged Heart (upon radiological exam)

Goiter (enlarged thyroid gland)

Constipation

Constipation

Hypothermia

Extreme sensitivity to cold

Delayed or early onset of sexual development

Irregular menstrual periods

Elevated cholesterol levels in the blood

Hoarse Voice