A 30-year-old male demonstrated a subtle onset of the following symptoms: dull f

Question

A 30-year-old male demonstrated a subtle onset of the following symptoms: dull facial expression; droopy eyelids; puffiness of the face and periorbital swelling; sparse, dry hair; dry, scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (hematocrit 27); enlarged heart (upon radiological exam); constipation, and hypothermia. Plasma concentrations of total and free T4 and T3 follow: Radioimmunoassay (RIA) of peripheral blood indicated elevated TSH levels. A TSH stimulation test did not increase the output of thyroid hormones from the thyroid gland. 1. What endocrine organ is involved here? 2. Is this a primary or secondary disorder? Why? (Is a TSH or TRH determination necessary for your diagnosis?) 3. Describe the feedback loop involved, indicating if there is an increased or decreased TSH level. 4. List several defects that could cause these symptoms. 5. Would you expect to find a palpable goiter? Explain your answer. 6. Describe a suitable treatment for this individual.

Explanation / Answer

1. What endocrine organ is involved here?

Ans.The endocrine organ involved here is the thyroid gland

2. Is this a primary or secondary disorder? Why? (Is a TSH or TRH determination necessary for your diagnosis?)

Ans.This is a primary disorder because the TSH stimulation test did not increase the output of thyroid hormones from the thyroid gland. Yes,Circulating TSH or TRH levels are useful for making the diagnosis because:

Circulating levels of TRH would be helpful but not necessary.

3. Describe the feedback loop involved, indicating if there is an increased or decreased TSH level.

Ans.The feedback loop involves the following:

TRH from the hypothalamus stimulates the anterior pituitary to release TSH , which in turn stimulates the thyroid gland to relapse the levels of T4 and T3. With low circulating levels of thyroid hormones, the negative feedback will cause an elevation in TSH output. Even with the elevated TSH, the thyroid gland is unresponsive and does not increase the hormonal output.

4. List several defects that could cause these symptoms

Ans.Any one of the following defects could cause these symptoms:

5. Would you expect to find a palpable goiter? Explain your answer.

Ans.There may be a palpable goiter as there is an elevated circulating level of TSH due to the negative feedback stimulus from low circulating levels of thyroid hormones. This chronic TSH stimulation may cause hypertrophy of the gland,therefore leading to goiter.

6. Describe a suitable treatment for this individual.

Ans.

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