Hyperthyroidism Case Study

Introduction

Patient A is a 49 year old female of 76 kilograms and height of 161.5 centimetres. The patient has attempted to diet but has gained 11.3 kilograms in the previous months. The patient also sleeps for 14-16 hours a day. Her movements were slothful. The patient’s signs consisted of a slight enlargement of the neck area, coarse textured hair and dry skin. When her blood sample was analysed it showed that the hormone T4 (thyroxin) levels were 3.2 micrograms/millilitre which is lower than the normal range, 4.2-11.2 micrograms/millilitre. In addition to this her TSH (thyroid stimulating hormone) levels were high.

Diagnosis

The analysis of the weight gain using the diagnosis table shows that this could be as a result of hyperthyroidism or Cushing syndrome or hypothyroidism. The slothful behaviour could be caused by Addison’s disease or hypothyroidism. The dry skin of the patient is consistent with the hypothyroidism condition.

The swelling on the neck could be a goitre which results from a lack of iodine in the thyroid gland. Overstimulation causes the thyroid gland to swell. This swelling could also be a result of hyperthyroidism whereby the thyroid gland secretes too much thyroid hormone and the swelling also results, or it could be a thyroid tumour which also causes the swelling. [1,2]

The signs and symptoms are consistent with either hypothyroidism or hyperthyroidism and are on the thyroid gland.

Cross-section diagram of the neck showing the thyroid gland (106.gif)

http://www.patient.co.uk/health/Hypothyroidism-Underactive-Thyroid.htm

Analysis of blood samples and effect of hormones on homeostasis

The hormone T4 speeds up metabolic rates regulates the amount of oxygen used up by cells and regulates body heat. [3] The patient’s weight gain could be as a result of a decrease in the rate of digestion. Low T4 levels mean that not enough digestive juices are being secreted because T4 controls metabolic rates resulting in the slow movement of smooth muscles lining the stomach. T4 promotes the normal development of muscle tone and normal functioning of skeletal and cardiac muscles. This possibly explains why the patient is experiencing slothful movement. [1] In addition to this T4 also promotes the hydration of the skin, secretion of the exocrine glands and the growth of hair. The consequences of low T4 could explain why the patient’s hair is coarse and why the patient has dry skin. [1]

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To distinguish between hyperthyroidism and hypothyroidism a T4 and TSH test have to be done. [4] The TSH test is normally chosen for the evaluation of the thyroid function and for the symptoms of hyperthyroidism or hypothyroidism. It is often done with or after a T4 test.

The results of the tests performed show an elevated TSH level and a low T4 level which show that the patient has hypothyroidism.

Condition

Normal

Hyperthyroidism

Hypothyroidism

Hypothyroidism Secondary

TSH

Normal

Low

High

Low

T4

Normal

High

Low

Low

[4]

WHAT IS HYPOTHYROIDISM

Hypothyroidism is a condition caused by the underactive functioning of the thyroid gland whereby the thyroid does not produce enough or does not even produce triodothyronine (T3) and thyroxin (T4). [1] The thyroid gland is a butterfly shaped organ which is found inferior to the Larynx and in front of the neck. [1] If the thyroid is underactive hypothyroidism appears. They are two types of hypothyroidism and these are primary and secondary hypothyroidism. [4] Primary Hypothyroidism is when the thyroid does not produce T4 and T3 hormones at all. [4] Secondary Hypothyroidism is when the thyroid produces amounts of T3 and T4 which are below the normal levels. [4] The thyroid gland swells up in as a result of it trying to achieve homeostasis. The body has low T4 levels therefore the gland works even harder to try and produce more hormones and this causes an increase in the size of the gland.

Causes

95% of the time the thyroid gland is not secreting sufficient thyroid hormone and this could cause the hypothyroidism.

Hypothyroidism could be an autoimmune disease. The immune system protects the body from foreign substances and infection. However, in this case the immune system mistakes the thyroid gland cells and enzymes, as foreign objects and attacks them resulting in the low production of thyroid hormone. [5]

Hypothyroidism could also be as a result of Hashimoto disease (chronic thyroiditis). This is a genetic autoimmune disease which could also result the enlargement of the thyroid gland causing goitre. Goitre is a cyst like fibrous growth in the neck region and is caused by an immunologic dysfunction or by an infection and requires lifelong treatment. Stress, poor dieting and strenuous exercise could also cause an imbalance of hormones and leads to hypothyroidism. [6]

Hypothyroidism can also result from low iodine concentrations in the body. Iodine is required for the proper and normal functioning of the thyroid gland’ hence insufficient amounts would cause a dysfunction. [5] The enlargement of the gland is an attempt by the thyroid gland to trap more iodine. X-ray radiation, drug abuse and pesticide residues also contribute to having an underactive thyroid gland. [7] Another way of acquiring hypothyroidism could be the after effect of a surgery for example on the removal of thyroid glands. The surgery could be performed on a patient with cancer or the Grave’s Disease but if partially removed it could fail to produce enough thyroid hormone necessary to regulate normal and necessary bodily functions. [7-8] Surgery could also be performed on the pituitary gland which sends instructions to the thyroid gland on how much thyroid hormone should be produced. [5] Any damage to the pituitary gland or the hypothalamus could cause hypothyroidism as they both play a role in sending signals to the thyroid gland so that it produces more thyroid hormone.

In some cases the condition could arise from the use of drugs such as amiodarone, lithium interferon alpha, and interkulin-2. These drugs stop the thyroid gland from producing the thyroid hormone at a normal and are likely to trigger hypothyroidism especially in patients with a genetic tendency to auto immune thyroid disease. [5]

Possible Treatment methods

To treat hypothyroidism artificial hormones such as Levothyroxine or Liotrix can be administered to the patient so as to replace the hormones; T4, TSH or T3 that are lacking in the body. Iodine supplement’s or iodised salt for those with iodine deficiency can be effective as well. [9-10] The doses of the drugs are not fixed hence the medicine is only formulated when the amount of hormone in the patient has been determined, therefore the patient has to return for constant check-ups after 6 week intervals so that the blood samples and the hormones can be analysed again so that the dosage can be changed. [7-10]

When treating the elderly that have a history of heart disease, low doses of the drug have to be administered as this could lead to a greater/increased risk of heart attack. [10]

For the short term treatment of hypothyroidism, T hormones are used to inhibit the synthesis of TSH in the body. Hormone replacement is predominated by the prolonged effect of T hormones on the level of TSH present.

For those who do not prefer drug therapy for hypothyroidism homeopathic remedies are also available. The homeopathic remedies such as Thyax and Thyroidinum 6C can be used to stimulate the thyroid gland to start to produce its own hormone. [11-12]

Prognosis

If the condition of hypothyroidism is detected early there is a high chance that the condition can be completely controlled using medicine.

After treatment with drugs, the levels of thyroid hormones usually return to normal after several months, whereas in other individuals suffering from hypothyroidism, the disorder is a lifelong problem. [13] Their treatment should be taken consistently every day for the rest of their lives. [14]

If hypothyroidism goes untreated it could lead to other complications. Low thyroxin levels cause the level of lipids and cholesterol to rise, causing the patient to suffer from heart disease. [13] In pregnant women there is an increased risk in having anaemia, still birth and serious bleeding after birth or it could lead to a myxoedema coma, which arises due to the low levels of thyroid hormone. [13-14]

Advantages and disadvantages of chosen treatment methods

With allopathic remedies there is a chance that if the drug dosage is too low it could cause hypothyroidism and if the drug dosage is too high it could lead to hyperthyroidism.

The homeopathic remedies are the best treatment methods as compared to the supplementation medications as it aids the gland to function properly, whereas in the supplementation medications the gland could become too dependent on the drugs and throw the other glands in the body off balance. [12] If the doses of the artificial hormones are not check or changed, with time this could lead to hyperthyroidism.

Prevention methods

There are no medication preventative methods for hypothyroidism, but a healthy diet can protect and preserve one’s health. The patient can take iodine supplements in their food and this reduces the risk of them contracting it. Exercising, getting enough sleep, relaxation are ways in which hypothyroidism future problems can be avoided. Exercise is another activity that boosts the levels of thyroid hormone therefore reducing the risk of hypothyroidism. [15]

Conclusion

There is no cure to the condition therefore the patient will have to keep taking medicine for the rest of their lives. The patient will have to go for constant check-ups in order to change the dose according to the thyroid hormone levels that they have, and the misuse of the drugs could make their condition worse. [16]