Nursing Case Study: Hypothyroidism, Diagnosis, and Treatment Analysis

This case study analyzes a 46-year-old primary school teacher presenting with fatigue, muscle aches, and forgetfulness, indicative of hypothyroidism. The study delves into the causes, clinical manifestations, and physiological mechanisms underlying the condition. It examines the patient's medical history, vital signs, and laboratory results, including elevated TSH levels and the presence of anti-thyroglobulin and anti-thyroid-peroxidase antibodies, pointing towards Hashimoto's thyroiditis, an autoimmune disease. The discussion covers the role of the thyroid gland, thyroid hormone production, and the impact of hypothyroidism on metabolism, cardiovascular, nervous, and reproductive systems. Furthermore, the case study explores treatment options, primarily thyroid hormone replacement with levothyroxine, and the use of ACE inhibitors to manage high blood pressure. The study concludes by emphasizing the need for prompt diagnosis and management of hypothyroidism and Hashimoto's thyroiditis.

Running head: CASE STUDY NURSING
CASE STUDY NURSING
Name of the student:
Name of the university:
Author note:

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Introduction:
Hypothyroidism has emerged as a health condition where the thyroid gland failed to
produce adequate thyroid hormones for meeting metabolic the needs of the body. In the United
Kingdom, 3.5 per 1000 women and 0.6 per 1000 men exhibit hypothyroidism where 30 to 40%
of the patients are either over-treated or undertreated (Nicholas et al. 2017). The common
symptoms of the disease include fatigue, muscle ache, stiffness, and cold dry skin. The case
study represents a 46-year-old primary school who is experiencing symptoms of hypothyroidism
(Okosieme et al. 2016). Hence, this paper aims to provide hypothyroidism and its common
causes, clinical representations of hypothyroidism, interpretation of data, Hashimoto thyroiditis
and suitable treatment in the following paragraphs.
Discussion:
Hypothyroidism:
The thyroid gland usually produces two thyroid hormones such as TS3 and TS4 that
regulate the normal metabolism of the body and develop by releasing the bloodstream. The
thyroid gland uses iodine from nutrition to produce these two hormones. However, due to
etiological factors, the thyroid gland failed to produce adequate thyroid hormones which directly
impacted the body function, metabolism, and sexual function which resulted in hypothyroidism
(Kumar and Clark 2013). Consequently, hypothyroidism impacts brain development, heart and
nervous system, body temperature and skin integrity, menstrual cycle and weightless and patients
exhibit muscle aches, stiffness, weight gain as observed in this case study. Taylor et al. (2018),
suggested that the most severe form of hypothyroidism is observed in infants with congenital

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thyroid deficiency. Lack of treatment through supplemental therapy soon after birth leads to
cretinism, a condition where irreversible growth, as well as mental retardation, observed.
A common cause of hypothyroidism:
While hypothyroidism can result from any condition that can lead to thyroid hormone
deficiency, two widely observed causes of hypothyroidism include iodine deficiency and primary
thyroid disease (Kierszenbaum and Tres 2015). Taylor et al. (2018), suggested that iodide is a
necessary component of the thyroid hormone since without sufficient iodine intake thyroid
hormone cannot be produced, indicating that individuals with iron deficiency eventually exhibit
that symptom of hypothyroidism. On the other hand, inflammatory diseases of the thyroid that
destructed various tissues of the gland can induce hypothyroidism. Furthermore, childhood
lethargy, fatigue, cold tolerance, reproductive failure, and hairlessness are also common
contributing factors of the thyroid (Mullan et al. 2018).
General clinical presentation of hypothyroidism:
While various clinical manifestations of hypothyroidism present, the symptoms may
vary from person to person. The common symptoms include infertility, poor foetal and neonatal
brain development, increased blood cholesterol, reduced heart rate, weight gain, muscle aches,
decreased sweating. Physiological role related to symptoms:
Metabolism:
Thyroid hormone regulates various metabolic process lead to the high increase in BMR
which resulted in high body heat production and increased oxygen consumption; therefore,
individuals with hypothyroidism exhibit low body heat production and low BMR (weight gain).
Since the thyroid hormone regulates fat mobilization and oxidation of fatty acids, high blood
cholesterol concentration often is a common clinical manifestation of hypothyroidism. The

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thyroid hormone regulates carbohydrate metabolism, especially the enhancement of insulin-
dependent entry of glucose (Www.niddk.nih.gov. 2020). Hence, proper carbohydrate metabolism
becomes impaired in patients with hypothyroidism. As the hormone regulates the growth of the
individuals, lack of adequate hormone leads to poor development of the neonatal and foetal brain
(Bassett and Williams 2016). Moreover, thyroid hormone influences the organ functions such as
the cardiovascular system, central nervous system, and reproductive system. Hence, patients with
hypothyroidism have a dysfunctional cardiovascular system which resulted in bradycardia, low
cardiac contractility, reduced vasodilation. The central nervous system negatively impacted due
to inadequate thyroid hormones where patients become sluggish, become anxious and nervous.
On the other hand, the reproductive system is controlled by thyroid hormones since it regulates
the menstrual cycle and fertility (Van der Spek, Fliers and Boelen 2017). In this context,
inadequate thyroid hormone leads to infertility. All of these symptoms are exhibited by the
patients indicated that the patient has hypothyroidism.
Clinical data interpretation of the data:
The case study highlighted that the patient had a past history of celiac disease and have
increased forgetfulness. She complains to her GP regarding fatigued, muscle aches, stiffness
around her neck and she reported to have plaques, sore throat, shingles, and gum bleeding, all of
these symptoms justify hypothyroidism since thyroid hormone regulator majority of the body
function.
Vital signs:
The blood pressure of the patient is high (140/95 mmHg where the normal range is
120/80) due to increased peripheral vascular resistance that is regulated by the thyroid gland. The
pulse rate of nearly high (98 per minute whereas the normal range is 60 to 100bp) (Cardona-

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Morrell et al. 2016). Respiration rate is normal (16 per minute) since the normal range is 12 to 24
beats per minute. Body temperature is also normal (36. 5 degree C) were 37 degrees Celsius.
However, physical examination of the patients suggested that both thyroid lobs are diffusely
enlarged with firm consistency which is common in this case of Hashimoto's thyroiditis where
the thyroid gland is always enlarged in due to inflammation and tissue destruction (Cardona-
Morrell et al. 2016). The patient had a history of celiac disease which may contribute to an
autoimmune reaction. Cold dry rough skin is another symptom of inadequate thyroid hormone
production as thyroid hormones regulate skin integrity. Moreover, non-pitting oedema around
ankles usually observed in the case of pretibial myxedema which is common amongst
individuals with hypothyroidism. The laboratory report of the patient suggested that patients
have high serum TSH levels (15 mU/L whereas 0.4 – 4.5 mU/L) but low free thyroxin level (10
to 20pmol /L) and low triiodothyronine (T3). She exhibited significantly elevated levels of anti-
thyroglobulin and anti-thyroid-peroxidase which is common amongst the patients with
Hashimoto thyroiditis where the T lymphocytes are observed against these antibodies (Cellini et
al. 2017). The complete blood count suggested a low RBC level. Hence, the patient might be
suffering from Hashimoto thyroiditis.
Hashimoto's thyroiditis:
Hashimoto's thyroiditis is considered as a health condition where inflammation of the
thyroid gland is observed. It is an autoimmune disease where body improper attacks the thyroid
gland by considering it as foreign tissue. It is considered as one of the common aetiological
factors of hypothyroidism. The common cause of Hashimoto’s thyroiditis is a combination of
environmental factors and genetic factors (Cellini et al. 2017). Hu and Rayman (2017),
suggested that individuals with type 1 diabetes and celiac diseases tend to exhibit Hashimoto's

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thyroiditis as observed in this case study. Kahaly et al. (2016), suggested that the blood of the
patients with Hashimoto's thyroiditis highly predominant with hormone antibody against thyroid-
specific proteins such as thyroperoxidase and thyroglobulin. The immunology of the disease
suggested that patients with T lymphocytes are involved in the process where due to
environmental factors or presence of autoimmune disease, it invades the gland and causes silent
inflammation that leads to the destruction of tissues and cells. Hashimoto’s thyroiditis is
associated with CTL4 polymorphism and when it down-regulates, it transmits an inhibitory
signal to T lymphocytes which resulted in the clinical manifestations of the disease. On the other
hand, environmental factors responsible for the pathogenesis of the diseases include low iodine
factors, infections, and the consumption of certain drugs.
Considering the prevalence rate amongst the patients, women are highly susceptible to
the development of Hashimoto's thyroiditis compared to men. The incidence report in the United
Kingdom suggested that the incidence rate of disease estimated at 3.5 / 1000 per year in females
whereas it 0.8 / 1000 per year in males. It is observed up to 10% in the population where the
prevalence rate is increased over time. While the prevalence rate is 10.3% in women, the rate is
2.7% for males (Endocrinefacts.org. 2020).
Suitable treatment:
Since hypothyroidism caused by Hashimoto’s Thyroiditis, the most suitable therapy
would be thyroid hormone replacement agents such as levothyroxine, triiodothyronine where the
TSH levels must be kept under 3.0 mIU/L (Cellini et al. 2017). Moreover, since the patient had
high blood pressure, angiotensin-converting enzyme inhibitors can be provided to the patients.
An angiotensin-converting enzyme inhibitor is dilated the blood vessels for improving the
amount of blood that the heart pump and lower the blood pressure (Cellini et al. 2017).

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Conclusion:
On a concluding note, it can be said that Hypothyroidism has emerged as a condition that
impacted a significant number of individuals around the globe. In the case of Hypothyroidism,
the thyroid gland failed to produce adequate thyroid hormones which directly impacted the body
function, metabolism, and sexual function. The common clinical manifestations include poor
foetal and neonatal brain development, increased blood cholesterol, reduced heart rate, weight
gain, muscle aches. The clinical data of the patient suggested that the blood pressure of the
patient is high, decreased RBC count and anti-thyroglobulin (anti-Tg) antibody and anti-thyroid-
peroxidase (anti-TPO) levels were significantly elevated. These clinical representations
suggested that Hence, the patient might be suffering from Hashimoto thyroiditis. It is an
autoimmune disease where body improper attacks the thyroid gland by considering it as foreign
tissue where CTL4 polymorphism can be the major genetic factor. Since hypothyroidism caused
by Hashimoto’s Thyroiditis, the most suitable therapy would be thyroid hormone replacement
agents such as levothyroxine, triiodothyronine where the TSH levels must be kept under 3.0
mIU/L. it will not cure the disease but manage the symptoms.

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