Medical History
A 49-year-old female client, CP, visited the health care clinic for possible diagnosis of hyperthyroidism. Upon admission the nurse noticed C.P. wide eye appearance, slightly enlarged thyroid gland and swelling in the legs. CP age and gender places her at risk for a thyroid problem and she had lab work done. According to her lab work her T3 and T4 levels were increased while her TSH levels were decreased. Her lab value confirmed that she has hyperthyroidism and was prescribed pharmacotherapy by her health care provider. She was taking Propylthiouracil (PTU) 150 mg every 8 hours PO and Propranolol (Inderal) 20 mg PO Q.I.D. After some months her lab values were taken again and she still had elevated T3 and T4 levels.
Her healthcare provider then suggested a subtotal thyroidectomy which is the removal of almost all of the thyroid gland. Both patient and doctor agree that this would be the best outcome. CP needs some education about her thyroidectomy and the possible complications. CP will be educated on are identifying the signs of hypocalcemia and the possibility of respiratory complications since CP shows some concern about not being able to breath after surgery. The signs of hypocalcemia may be a potential risk factor for readmission. CP will
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To begin, the team should discuss the possible signs of hypocalcemia; this is because when removing the thyroid gland the parathyroid gland is also being removed. The parathyroid gland is responsible for the production on calcium. The symptoms of hypocalcemia are positive signs of Chvostek’s or Trousseau’s, tetany, muscle cramps, tingling sensation of the hands and feet as well as facial numbness (Lee et al., 2015). If CP were to show positive signs of hypocalcemia she would need to take her prescribed medication of calcium gluconate and to call her health care provider
pituitary is not creating as much TSH. This would cause the Thyroid to stop producing T4
She is currently on a regimen of Armour Thyroid 90 mg daily. Her TSH was last checked in November. She previously was on levothyroxine, but cannot recall the reason why she was switched. She thinks it was changed by her prior endocrinologist. She does not recall having a specific side effect or problem with the levothyroxine and would be interested, potentially in switching back to that because it is more considered standard therapy. She does feel sometimes that she is having difficulty losing weight, even though she is trying. Her weight in the office is actually down 2 pounds from her last visit in May, but overall up 5 pounds from her last visit a year ago in June. She also feels bloated sometimes, occasionally has constipation, but no other symptoms of hypo or
Mrs. J.P. is a 30-year-old African-American female who presents to the local health department for her annual women’s health exam and establishment of primary care. Mrs. J.P. requests a pregnancy test be performed due to her recent absence of menses. Mrs. J.P. states she and her spouse have been attempting pregnancy for approximately 3 months; however, with each missed cycle, pregnancy tests have been negative despite corresponding notable fatigue. Mrs. J.P. explains her current uninsured status and frustration with walk-in clinics stating recent use of multiple clinics for “simple things” without resolution. Mrs. J.P. lists her primary complaint as difficulty sleeping due to significant heart pounding in addition to her fertility concern. When encouraged to also explain recent symptoms requiring walk-in clinic assessment and completion of a health history form, she explains her ongoing diarrhea, current hand tremor, and recent onset of eye pain. She identifies all symptoms as explainable as Mrs. J.P. attributes a gluten allergy to her diarrhea, a family history of glucose abnormalities to her hand tremor, and seasonal allergies to her eye pain although medical assessment and diagnostics have not been performed. When encouraged to
In Ernest Hemingway’s The Sun Also Rises, Hemingway writes a novel centered around Jake Barnes and his post war lifestyle in Europe. Seán Hemingway wrote an introduction for the novel long after the original publication that Jake Barnes was written as a representation of Ernest Hemingway, Cohn was a representation of Harold Loeb, and Brett was a representation of Duff Twysden (1). Hemingway wrote this novel in order to showcase what it means to be lost in life, and part of Gertrude Stein’s lost generation. When reading the novel, it is clear to see that the characters, including Barnes, are lost in what they want from life. The audience primarily witnesses long nights of drinking and partying, but within those nights, often times the characters found themselves alone.
An 18-year-old woman presented with persistent bilateral lactation, excess body weight with leg swelling and unbalanced gait, and recurrent hypercalcemia. Patient experienced increasingly frequent headaches and visual field changes. Developed panhypopituitarism and central diabetes insipidus (DI) after going through with transsphenoidal resection of a pituitary macroadenoma. Patient was treated with levothyroxine (T4) for secondary hypothyroidism. She received other hormone replacement therapy, including desmopressin acetate, conjugated estrogen, growth hormone, and bromocriptine. She developed recurrent kidney stones and diagnosed with primary hyperparathyroidism. She was also found to have multiple thyroid nodules and underwent a 4-gland
The health care provider ordered blood work that included thyroid-stimulating hormone, triiodothyronine, thyroxine, and radioactive iodine uptake to confirm the diagnosis of hyperthyroidism. The labs returned with an elevated level of triiodothyronine and thyroxine, while the thyroid-stimulating hormone was decreased. There was also an
The patient’s diagnosis is primary overt hypothyroidism. The patient presents with certain features such as weight gain, weakness, excessively dry flaking skin, dry hair, sluggish movements, constipation, bradycardia, diminished deep tendon reflexes, and bilateral edematous hands, which is classical signs and symptoms for primary hypothyroidism. The patient laboratory test reveals she has an elevation in serum thyroid stimulating hormone level along with low serum free thyroxin and triiodthyronine levels, which indicates it is a dysfunction or abnormality in the thyroid gland as opposed to the pituitary gland or hypothalamus (Gaitonde; Lohano; Porth, 2015, p. 780; Ross, 2014).
If you have surgery, all or part of your thyroid gland may need to be removed as well.
A lot of the conditions discussed above can be treated, or even prevented, if regular tests are done to monitor the gland. Some of the routine tests that health care providers can use to check the functionality of the gland are TSH test, T4 tests, T3 test, thyroid-stimulating immunoglobulin (TSI) test, and the antithyroid antibody test (also called the thyroid peroxidase antibody test (TPOab)). All of these tests are blood tests and depending on if the patient is showing any symptoms of thyroid dysfunction, the health care provider may order more than one of these tests to be
As the most interesting patient presentation, two weeks ago there was a 50-year-old Hispanic woman who came to the clinic and complained of unintentional weight gain over 28 pounds in the last two years. The patient wanted to participate in the weight loss program. Upon the physical assessment, this patient stated that her family runs thyroid disorder issues. Prior to starting the weight loss management, my preceptor and I decided to run some lab works to assess her TSH, Free T4, T3, and some other test. The patient has a follow-up appointment in the following week for her lab result. The patient lab’s result abnormal thyroid hormones. She had hypothyroidism. She stated that she had a primary physician that she had seen over 10 years, and they never told her about this problem. The plan was to treat the thyroid problem by prescribing her Armour Thyroid starting at 30 mg. According to Woo and Wynne (2015), for patients who are clinically hypothyroid, replacement therapy with thyroid hormones is
The main goal of the treatment is to control the over-production o thyroid hormones. The anti-thyroid medications, for instance, have methimazole and propylthiouracil (PTU), which blocks the production of hormones of the thyroid gland. However, there could be some side effects such as allergies and hyperthyroidism may return if the drug is not being used. Sometimes, radioactive iodine treatment is preferred by doctor because it provides a long-term solution, unlike the medications. According to Toft, “Radioactive iodine works by destroying thyroid tissue cells, thereby reducing your thyroid hormone levels.” RAI is usually given as a capsule or in a water-based solution, and the treatment may take months to be effective. The last type of treatment is the thyroidectomy, which is a surgery. The removal of the thyroid gland may be required for some patients that cannot take or tolerate the medications or when those medications have no effect in controlling the overproduction of T3 and T4. Although the total removal of the thyroid gland treats most of the patients, the surgery always results in hypothyroidism, which is a condition where the body lacks sufficient thyroid hormones. In this case, patients that undergo total thyroidectomy need to intake a daily
In figure 1.1, a patient in her 20s is being seen for a sensation of fullness in her neck. The patient had further thyroid testing through ultrasound and other diagnostic tests. Even though she felt normal and her nodules were smaller than the recommended 1.5cm or above, she was told she might have an overactive thyroid by the physician and the patient was given radioactive iodine. The radioactive iodine does the same job as chemotherapy where it wipes out healthy cells along with cancerous cells leading to low or no thyroid function. When the patient came back for a follow up she complained of not feeling the same before she
My patient is a 30-year-old mother of two who presented with symptoms of fatigue, cold intolerance, and tearfulness. She was later diagnosed with Hashimoto’s Thyroiditis six months after the birth of her second child. With the addition of a thyroid hormone, prescribed by her doctor, the patient is doing well and living an active life with her husband and two children.
Burning of books is a sin for those who have knowledge. Burning books is burning knowledge that people could be learning from. When someone burns a book, it’s just like disobeying their parents, guardian, any person who is older than them, or even god. It’s a prevention of gaining knowledge for those who already have it or don’t have any knowledge at all. Burning books is taking away the knowledge of people and is causing the society to replace books with technology.
This approach is commonly recommended for the small groupof people who have such low degrees of thyrotoxicosis that ablative therapy with RAI,surgery, or risks of drug effects of antithyroid medications seem unnecessary. Thesepeople often do well with beta-blockers; however, they must be carefully monitoredsince thyrotoxicosis may worsen without warning. Also, the risks of worsening of osteo-porosis and chronic effects of excess thyroid hormone on the heart should be consid-ered. For these reasons, post-menopausal women with brittle bones (see Chapter 14)and people with irregular heart rhythms (see Chapter 25) are appropriately directedtowardRAI