CASE 1 THYROID DISEASE

History: A 50 year old housewife complains of progressive weight gain of 20 pounds in 1 year, fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.

Physical examination: Vital signs include a temperature 96.8oF, pulse 58/minute and regular, BP 110/60. She is moderately obese and speaks slowly and has a puffy face, with pale, cool, dry, and thick skin. The thyroid gland is not palpable. The deep tendon reflex time is delayed.

Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.8 ug/dl (N=4.5-12.5), the serum TSH is 1 uU/ml (N=0.2-3.5), and the serum cholesterol is 255 mg/dl (N<200).

1. What is the likely diagnosis?   Answer

2. What are the symptoms that made you consider that diagnosis?  Answer

3. What physical findings supported the diagnosis?  Answer

4. Which lab data supported the diagnosis?  Answer

Explain-Hypothalamic-Pituitary-Thyroid axis and interrelationship.

5. What are the most likely causes?  Answer

6. What additional aspects of the history and physical examination could provide relevant information to help in the diagnosis?  Answer

7. What additional tests would help confirm the diagnosis?  Answer

8. What are the treatment options?  Answer