Question

A 34-year-old woman comes to the practitioner's office complaining of feeling jittery all the time and suffering from intolerance to heat. She also states she can feel her racing intermittently and worried she may be having heart problems. The patient denies specific chest pain but only reports the jittery feelings and sometimes palpitations. She also states she even considered that she could be going through early menopause. Since her last visit 6 months ago, her weight has changed from 185 lbs to 170 Ibs Neurologic: Awake, alert, and oriented Cardiovascular: Blood pressure 122/76, HR 116 and irregular Pulmonary: Respiratory rate 20 per minute Additional findings: Patient is slightly diaphoretic, jittery, and note thinning of her hair What diagnosis do you suspect? What other symptoms would be associated with this condition that you would question the patient about? What is the cause of the jittery feelings the patient is experiencing? What lab tests would you order to confirm your diagnosis? Provide the normal ranges for the above labs? What are the treatment options for this condition? Discuss the pathophysiology of the suspected diagnosis. What medications would be indicated, if any? What dietary changes should the patient make? Discuss the specific discharge teaching that would be important for this patient

case study

Answer 1

Diagnosis:May suspect of hyperthyroidism: The patient symptoms related to symptoms of hyperthyroidism are jitteriness, weight loss, changes in menstrual pattern, diaphoresis, thinning, brittle hair, palpitation, arrhythmia, intolerance to heat.

other symptoms: Increased appetite : Ask about appetite pattern

Diarrhea : Ask about bowel pattern

Enlarged thyroid gland

Sleep pattern disturbance: Ask about sleep pattern

Fatigue & weakness: Ask about feeling of tiredness, giddiness

Cause of jitteriness: Hyperactive thyroid leads to increased thyroid hormone levels which leads to increased metabolic rate , increased energy production and causing increased nervous stimuli - which is leads to tremors.

Lab test: Thyroid function test (TFT)

normal values varies according to labs

TSH- 0.4- 4.0 mIU/L

Free T4- 0.7- 1.8 ng/dl

Free T3- 260- 480 pg/dl

Total T4- 5.4- 11.5mcg/dl

Total T3- 80-220 ng/dl

Treatment option:

Anti thyroid medications: Such as Prophylithiouracil, methimazole

Thyroidectomy- Subtotal or total if not controlled by anti thyroid medications.

Otherwise symptomatic treatments.

Pathophysiology

Enlarged or hyperactive thyroid leads to increased thyroid hormone levels production which leads to increased metabolic rate , increased energy production and causing appearance of signs and symptoms.

MEDICATIONS

Anti thyroid medications: Eg: Prophylithiouracil, methimazole

other medications are to treat symptoms antiarrhythmic drugs to treat arrhythmia, antidiarrheal medications to treat diarrhea.

Dietary change:

Advice to take non-iodized salt

Advice to reduce or avoid intake of sea foods which are rich iodine sources.

Advice to intake protein rich food items as they need to combat with increased metabolism and weight loss.

Discharge teaching

Explain about signs and symptoms of hyperthyroidism

Encourage to intake of anti thyroid medications regularly as per order without fail.

If skipped the medications - avoid double dose

Take adequate rest

Make adequate dietary changes such as low iodine, high protein

Regular monitoring of thyroid hormone levels, regular follow up as per physician advice.

Explain about signs and symptoms of hypothyroidism too.