This case study documents the symptoms, lab results, diagnosis, and treatment for a patient with hypothyroidism. The patient presented with symptoms including dull facial expression, dry skin, constipation, and an enlarged heart. Lab tests found low levels of T4 and T3 and an elevated TSH. This led to a diagnosis of primary hypothyroidism caused by insufficient thyroid hormone production. Treatment involves lifelong thyroxine medication to regulate metabolism.

1. Case Study: Hypothyroidism
Team: ATCG

2. SYMPTOMS
Dull facial Lethargy
expression Change of
Droopy eyelids personality
Puffiness of the face Bradycardia (60bpm)
Periorbital swelling 90/70 (BP)
Sparse, dry hair Anaemia
Dry, scaly skin Enlarged heart
Intellectual Constipation
impairment Hypothermia

3. SYMPTOMS (contd.)
Plasma
Concentrations
T4 T3
Total Found 3.0 µg/dL 0.14 ng/dL
Total Lower Limit 5.5 µg/dL 60 ng/dL
Free 0.6 µg/dL 0.01 ng/dL
Free lower limit 0.8 µg/dL 0.2 ng/dL
Elevated Thyroid Stimulating Hormone (TSH)

4. DIAGNOSIS
Hypothyroidism - Characterized by
insufficient thyroid hormone production.
Primary Hypothyroidism - Low thyroxine
(T4) and triiodothyronine levels (T3), high
TSH levels.
Secondary Hypothyroidism - Low
thyroxine (T4), triiodothyronine (T3) and
TSH levels.

5. Endocrine Gland: Thyroid Gland
Largest endocrine gland
Secretes thyroid hormones (T4 and T3)
Regulates the rate of metabolism in the body
Impacts every organ in the body
Source: American Thyroid Association

6. The Negative Feedback Loop
Major Hormones
T4 – 4 Iodine atoms
T3 – 3 Iodine atoms
Involves:
Hypothalamus
Pituitary gland
Thyroid gland
Source: Iodine Research Group, U.S.A.

7. Causes of Hypothyroidism
Autoimmune Disorder (Hashimoto’s
Disease)
Lymphocytic Thyroiditis
Thyroid Destruction
Pituitary or Hypothalamic Disease
Medication
Iodine Deficiency

8. GOITRE
Nodular enlargement of the thyroid gland
Causes:
Iodine deficiency or Primary hypothyroidism
Hyperthyroidism
Injury or Infection
Tumour (Cancerous and Benign)
Not present in all patients

9. Toxic Goitre – Tumour
Source: National Health Services, U.K.

10. Diffused Goitre – Iodine Deficiency
Source: British Journal of Anaesthesia

11. Nontoxic Goitre – Primary
Hypothyroidism
Source: University of Leeds, U.K.

12. TREATMENT
No Cure (Except in case of iodine
deficiency)
Thyroxine tablets (Lifelong medication)
Individually tailored dosage
Review
Change in circumstances
Every year

13. REFERENCES
VanPutte, C., Regan, J. and Russo, A. (2010)
Seely's Essentials of Anatomy & Physiology.
McGraw-Hill, New York.
American Thyroid Association (2008)
“Hypothyroidism“
http://www.thyroid.org/Information/
Hypothyroidism.pdf (Accessed 25 April 2010).
Cooper, D., McDermott, M. and Wartofsky, L.
(2004) Hypothyroidism. The journal of Clinical
Endocrinology & Metabolism, 89(110), 5-8.

14. TEAM: ATCG
THANK YOU