Case History #13 A 30 year old female visited her physician complaining of fatig

Question

Case History #13 A 30 year old female visited her physician complaining of fatigue, weight gain, diffuse alopecia, hearing impairment, "chills", and an inability to concentrate. The patient had recently left her job as an aerobics instructor due severe muscle cramping upon exercise and shortness of breath. The physician noted a heart rate of 50 beats per minute. The following laboratory tests were conducted (Normal values are in parentheses.):

Blood tests: Free thyroxine 0.6 ng/dL (0.8 to 2.0)

TSH 1.88 mU/ml (0.4 to 4.0) FSH 3.1 mU/ml (1.9 to 10.0)

Prolactin 42.3 ng/ml (3 to 20) Cholesterol 198 mg/dL (140 to 199)

Glucose 75 mg/dL (70 to 105) Erythrocytes 4.3 million/mm3 (3.8 to 5.1 million)

Mean (average) cell hemoglobin conc. 30.7% (33.0 to 37.0%)

Urine test: Free cortisol in 24 hour urine 29 mg/day (10 to 50 mg/day)

Questions (2 points each): 1. What is your diagnosis? Is this a primary (problem with the gland itself), secondary (problem with the pituitary), or tertiary (problem with the hypothalamus) disorder? 2. What is the significance of the elevated prolactin? 3. Explain the anemia. 4. What is the treatment available for this disorder? 5. Are there other endocrine abnormalities present? Briefly explain why or why not.

Explanation / Answer

1. The diagnosis is hypothyroidism. It is primary as the TSH levels are normal.

2. The elevated prolactin may signfies a pituitary tumor due to hypothyroidism.

3. The anemia here is due to hypothyroidism itself. Because it cause the alteration of haeme oxidation in liver. It causes a vicious cycle of iron deficiency and which will lead to anemia.

4. Treatment for hypothyroidism is THYROXINE. 50 microgram for 3 weeks followed by 100 microgram then 150 microgram .

5. All other parameters are normal ,so no other endocrine disorder is present.

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