HYPOTHYROID DISEASE

Patient Case

Initial Presentation

Mrs. K.G. is a 29-year-old white female who was eight months pregnant at the onset of her illness. She is 5’2” tall and weighs 140 pounds. She has a son and daughter from a previous marriage. She has also suffered one miscarriage previously. Upon calling her PCP’s office and complaining of a severely sore throat, a temperature of 102° F, and the initiation of mild uterine contractions, she was instructed to go immediately to the emergency room. The ER physician chose to hospitalize her and treat her with antibiotics and IV magnesium sulfate to stop the contractions. Three days later, the fever resolved and there were no more contractions. K.G. felt much better and she was released from the hospital.

HYPOTHYROID DISEASE

Medical History

Up to this time, the patient had been in excellent health. The only medications that she was taking were prenatal vitamins. She had no known allergies, did not drink or smoke, and did not use illegal drugs.

Clinical Course

Four weeks later after an uncomplicated delivery K.G. gave birth to a healthy female child. Approximately six weeks later K.G. saw her PCP with multiple clinical manifestations. She complained of being tired and weak. She also complained of lots of aches (both joint and muscle pain), that she was cold all the time, and that she had gained 30 pounds since her last delivery. When asked specific questions by her PCP, she also admitted (since her last delivery) to having recurrent headaches, mild constipation, and a lack of a menstrual period. "Could I be pregnant again?" she asked. A pregnancy test was conducted but determined to be negative. It was recommended that she take ibuprofen for her joint and muscle pain. A preliminary diagnosis of rheumatoid arthritis was considered, but a blood test for rheumatoid factor was negative.

HYPOTHYROID DISEASE

Clinical Course

K.G. returned to her PCP two weeks later. She noted that the ibuprofen had been somewhat effective for pain but not completely. The PCP ordered an ESR (which was 60 mm/hr.). K. G. also mentioned that she was having difficulty hearing and comprehending and that she often felt “closed off in another world oblivious to what was going on around her.” She also told her PCP that she “felt physically and mentally sluggish all the time.” The PCP noted that her speech was very slow and deliberate, her voice was hoarse, her hands were swollen and her face puffy, and her skin was extremely dry and flaky. Heart rate was 46 beats/minute. There was no thyromegaly. K.G. told the PCP that she could not drive anymore because her “alertness was gone” and her reaction time was slow. Because of her poor mental state, she also could not care for her two young children anymore and her mother was providing care for them.

Three days following her last visit with her PCP, K.G. was thoroughly evaluated as a large medical facility. X-rays were taken of her hands and chest. CT scans were conducted of her neck, chest, and abdomen. She was given another ESR and pregnancy test, and a complete blood chemistry panel was run. During her clinical assessment, she received frequent hot compress applications to her hands, neck, and shoulders from a physical therapist and received daily hot whirlpool baths for her many aches and pains.

HYPOTHYROID DISEASE

Laboratory Blood Test Results

See Patient Case Table 59.1

Patient Case Table 59.1 Laboratory Blood Test Results
Na+                      128 meq/L	WBC               11,500/mm3	ESR                              55 mm/hr
K+                         3.5 meq/L	Plt                    250,000/mm3	Thyroperoxidase antibodies      (-)
Ca+2                     9.8 mg/dL	WBC differential: 45% neutrophils, 45% lymphocytes, 6% monocytes/macrophages, 3% eosinophils, 1% basophils	Thyroglobulin antibodies           (-)
Cl-                        101 meq/L	T4, total         3 μg/dL	Pregnancy test                          (-)
Glu, fasting           108 mg/dL	FT4               6 pmol/L	Cholesterol                   260 mg/dL
RBC                      3.9 million/mm3	T3                 80 ng/dL	Calcitonin                     0 pg/dL
Hct                        33%	TSH              25 μU/mL

Note: Normal values, please refer to Laboratory Values posted on Canvas

HYPOTHYROID DISEASE

Treatment

K.G. was prescribed oral 75 μg levothyroxine daily and she noticed a dramatic improvement in her personal health within 72 hours. There was a marked improvement in her alertness and thought processes and she felt considerably less tired and weak. Within four weeks of initiating therapy, all her aches, pains, and edema subsided and she felt normal again.

HYPERTHERMIA

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Abbreviations

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Abbreviations