Thyroid Disease, Case Study Example

The Patient’s name is Jane Wiley, she was born on November 7, 1983 and is currently 27 years old. The patient complains of feeling cold, tired and experiences decreases in appetite, yet is followed by weight gain. She is a Caucasian female who has no family history of hypothyroidism. The patient complains of constant constipation, has been diagnosed with arthritis in the past and sustains a traumatic brain and neck injury in 2003. She takes Excedrin for her frequent headaches. The patient appears to be healthy and of stated age, she seems cleanly and neatly dressed; no signs of issues concerning hygiene. The patient however shows signs of per orbital puffiness on signs of a goiter. All auscultations are normal and no abnormalities are found in the chest and abdomen. She does however show a delayed reaction of deep tendon reflexes in her neuro test, it was remarked that the patient also has cold skin. The patient has been diagnosed with hypopituatarism; this is believed to be secondary to brain injury. She has neuropathy in the right and the left hands, as well as some signs of edema in the hands and the feet. The awareness for her brain injury may have caused her pituitary gland damage as well. This can be seen as preventing patients from having to cope with endocrine disorders on their own. This risk in the pituitary gland can cause elevated risks of diabetes, hypoituitarism and other illnesses relating to endocrinopathies; this can come as physically and psychologically from appropriate hormone replacement therapy (HRT) patients.

Anterior pituitary insufficiencies have been reported to be caused by pathologic factors, this was first found in 1914; it is sometimes referred to as Simmond’s disease. TBI is seen to pose a significant risk of pituitary insult as well as hypothalamic damage (Urban RJ, Harris P andMasel B). These can come as structural abnormalities which are seen as anterior lobe necrosis, posterior lobe haemorrhage, or stalk laceration. Growth hormone deficiencies are seen in patients whom have TBI; this is due to growth hormone-secreting somatotrope cells. These cells are located in the wings of the pituitary gland; the vascular supply and oxygen which the patients receive are released through the hypothalao-pituaitary portal vessels. This cases cell death due to restriction of oxygen.

The patient has hypothyroidism due to the following symptoms: the patient has fatigue and is experiencing some weakness, she claims of intolerance to cold, her skin is cold, she takes medication because of frequent headaches, there is swelling of the face as well as extremities; this can be expressed in the arthritis the patient claims to have, there is weight gain yet a decreased appetite and the patient has constipation (Bucurescu).

The patients’ goals should be established, both psychologically and physiologically. The patient may be experiencing anxiety because of the weight gain and a loss of self-esteem. She has been having a decrease in appetite, yet she is continually gaining weight and is at a status of obesity. The first goal to be seen here is to help the patient know and understand her condition well. Another goal for the patient is to gain social support from friends and family. Her diagnosis not only affects her, but those around her. With adequate support, treatment for the diseases she has been diagnosed with may seem lighter. The patient also must go through medical treatment for her hypothyroidism, and also go through rehabilitation for her TBI for the improvement of her motor skills and her neurological responsiveness.

The treatment for Hypothyroidism is seen as the reversal of clinical progression (O’Malley B, Hickey J andNevens E). Thyroid hormone shall be administered to supplement or replace endogenous production in the patient. Simply put, hypothyroidism can be treated with a constant and daily dose of levothyroxine. Clinical benefits for this treatment are said to be seen in 3-5 days, and they will start to level off after 4-6 weeks of continuous treatment. Anticipated full replacement can be administered to the patient since she is an individual who is young and looks clinically healthy. Achieving the ideal TSH level for the patient within the reference range may be slowed because of the hypothalamic pituitary axis; cases might be that re-adaptation takes several months (O’Malley B, Hickey J andNevens E). However, it is said that with dose stabilization, patients are monitored with evaluations and TSH monitoring. The patient should be checked routinely for any signs or symptoms of over treatment; this could include the following symptoms: tachycardia, palpitations, nervousness, tiredness, headache, increased excitability, sleeplessness, tremors, and possible angina. According to studies, a meta-analysis of randomized control trials which included thyroxine-triiodothyronine combination therapy (T4 + T3) and thyroxine monotherapy (T4) for treatment of clinical hypothyroidism found no difference in the effectiveness of the combination vs monotherapy in bodily pain, depression, fatigue, body weight, anxiety, quality of life, total cholesterol, LDL-C, HDL-C and triglyceride levels. It was found that the method of T4 monotherapy remains the treatment of choice (O’Malley B, Hickey J andNevens E). Besides this, the patient will also be going through rehabilitation therapy to help her TBI.

The range or level of her TBI should first be measured. Seeing as she only has very minor symptoms which show, the patient will go through inpatient management (Fary Khan, Ian J Baguley and Ian D Cameron). This is required only for those who have acute physical and/or behavioral deficits due to TBI. This will focus on monitoring, retraining in activities of daily living as well as pain management. Additionally, it will be seen that the patient receives cognitive and behavioral therapies, pharmacological management and assistive technology.

Following discharge from inpatient management, the patient will undergo community rehabilitation (Fary Khan, Ian J Baguley and Ian D Cameron). This is where she will resume maximum independence with the help of the community. This involves much family support, education and counseling. It should be noted that patients who have hypothyroidism are also at risk for ligamental injury; this must be noted during the patient’s rehabilitation process for her TBI.

Nursing intervention was effective. At first, the patient seemed reluctant to participate in the activities for rehabilitation; however after the treatment for her hypothyroidism started showing results, the patient was more responsive to rehabilitation. The patient responds well to the treatment as she is fairly young and maintains a healthy lifestyle. Her headaches are said to decrease, and there is an improvement seen in her motor skills. It is suggested that she continues treatment for her hypothyroidism and maintains a diet which is fit for the treatment. This is seen as decreasing levels of iodine intake. The patient still has symptoms similar to arthritis, and the patient’s weight is not significantly changing, yet levels of hormones are seen to regulate.

It is recommended that in future cases, all possible illnesses in connection with TBI should be examined. It has been said that a large percentage of Americans have died because of TBI and untreated conditions. The patients’ hypothyroidism could not have been detected, and it was fortunate that she sought medical help. The decrease in her appetite might have led her to malnutrition and further depression; also she could have gone without treatment. When the patient sought medical attention, she was still in a seemingly healthy condition. If this treatment were to have waited, many types of negative symptoms may have arose.

Works Cited

Bucurescu, G. “Thyroid Disease”. E Medicine. January 2009. Retrieved from  http://emedicine.medscape.com/article/1172273-overview

Fary Khan, Ian J Baguley and Ian D Cameron. “Rehabilitation after traumatic brain injury”. E   Medical Journal of Australia. 2003: 178.6: 290-295. Retrieved from  http://www.mja.com.au/public/issues/178_06_170303/kha11095_fm.html

O’Malley B, Hickey J andNevens E. “Thyroid dysfunction — weight problems and the psyche: the patients’ perspective”. Journal of Human Nutrition and Dietetics. 2000; 13.4.

Urban RJ, Harris P andMasel B. “Anterior hypopituitarism following traumatic brain injury”. Brain Injury. 2005: 19.5.