Allison is a 32-year-old female with the following symptoms: dismal facial expression; droopy eyelids; swollen face and periorbital areas; thin, dry hair; dry, crusty skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (59 b/min); blood pressure of 93/72; anemia (hematocrit 28); enlarged heart (upon radiological exam); constipation, and hypothermia. Plasma concentrations of total and free T4 and T3 include:
|
T4
|
T3
|
|
Total
|
3.1 µg/dL
|
0.15 ng/dL
|
|
Free
|
0.5 ng/dL
|
0.02 ng/dL
|
Elevated TSH levels were seen from the results of a Free Radioimmunoassay (RIA) of peripheral blood. A TSH stimulation test did not increase the output of thyroid hormones from the thyroid gland.
- What endocrine organ is involved in this situation?
- Is this a primary or secondary disorder? Explain.
- Describe the feedback loop involved. Signify if there is an increased or decreased TSH level.
- List several defects or disorders that could cause these symptoms.
- Would you expect to find a palpable goiter? Why?
- Describe an appropriate treatment for this patient.