Question A 42-year-old woman has noticed dry skin, fatigue, and weight gain over the past three months. Her blood pressure is 110/70 mm Hg, pulse 60/min, and heart and lungs are normal. Her skin feels rough and dry, but the rest of her examination is normal. Her biochemistry is normal, but the TSH is 39 mU/L. Case Study-42-Year-Old Woman Case Study-42-Year-Old Woman – Discuss the patient’s situation – Provide at least three possible differential diagnoses and justify your rationale. -Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

Case Study-42-Year-Old Woman

The 42-year-old woman presents symptoms of dry skin, fatigue, and increased weight gain. She also has a TSH of 39 mU/L, which is way above the normal TSH levels for an adult her age. The high TSH levels are a potential indication of a problem with the thyroid gland. If the thyroid gland is underactive, it will not produce enough thyroid hormones.

Possible Differential Diagnosis

Hypothyroidism  

Primary hypothyroidism is the most probable diagnosis based on the symptoms the patient presents. There are a number of reasons supporting this diagnosis. Firstly, the patient has very high TSH levels. The normal range for TSH levels in healthy adults is between 0.4 and 4.0 mU/l (Chiovato et al., 2019). Although the symptoms of hypothyroidism are non-specific, high levels of TSH are the major symptom of an underactive thyroid and, thus, hypothyroidism. Hypothyroidism occurs when the thyroid gland fails to secrete adequate levels of thyroid hormones. This can lead to the development of the symptoms the patient presents, such as fatigue, weight gain, and dry skin. Another rationale for this diagnosis is based on the gender and age of the patient. The patient is a 42-year-old woman. Women at their pre-menopausal age go through increased hormonal changes and experience major hormonal deficiencies, thus the risk of thyroid gland problems and the development of hypothyroidism (Patil et al., 2022).

Hashimoto’s thyroiditis

The second most probable diagnosis is Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an autoimmune disorder that leads to the patient’s immune system attacking healthy cells and tissue, including the thyroid gland. An immune system attack on the thyroid gland can cause the thyroid gland to malfunction, resulting in a reduced production of thyroid hormones. This can lead to hypothyroidism and the presentation of symptoms such as fatigue, weight gain, dry skin as well as high levels of TSH. Being a woman in her pre-menopausal age, Hashimoto’s thyroiditis is a major cause of primary hypothyroidism (Patil et al., 2022).

Hypopituitarism

The main diagnosis based on the patient’s levels of TSH has been primary hypothyroidism, meaning that the patient’s condition indicates a problem with the thyroid gland itself rather than with the pituitary gland or hypothalamus. Nonetheless, there is a possibility that the thyroid gland’s failure to produce sufficient thyroid hormone may be due to under-stimulation due to a low supply of TSH. This can be a problem with the pituitary gland. Hypopituitarism, which involves the failure of the pituitary gland to produce sufficient amounts of hormones, can lead to symptoms the patient manifests, such as fatigue, weight gain, and dry skin, among others.

Therapeutic Plan

The therapeutic plan for the 42-year-old woman will aim to address the underlying risks of hypothyroidism. The recommended approach to managing and treating hypothyroidism is thyroid hormone replacement therapy (HRT) levothyroxine. The recommended dose for the replacement levothyroxine is usually to be started at 1.6 µg/kg/day (Chiovato et al., 2019). The dose can be reduced to 50 percent after a while based on the symptom’s improvement (Patil et al., 2022).

Besides the levothyroxine therapy, the patient will be required to engage in physical activity and make major lifestyle changes. Extensive patient education on hypothyroidism and healthy living will be integrated into the therapeutic plan. Improved knowledge of hypothyroidism, exercising, and changes in activities of daily living have been associated with improved management of hypothyroidism (Aqeeli & Hassan, 2022).

References

Aqeeli, M. AL, & Hassan, H. (2022). The Impact of An Instructional Program on Hypothyroidism Patients’ Knowledge Toward Physical Exercise and Activity Daily Livings. Kufa Journal for Nursing Sciences, 12(1). https://doi.org/10.36321/KJNS/2022/120108

Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Advances in Therapy, 36(2), 47–58. https://doi.org/10.1007/S12325-019-01080-8/TABLES/1

Patil, N., Rehman, A., & Jialal, I. (2022). Hypothyroidism. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK519536/