Mr. Singh presented with symptoms of irritability, forgetfulness, sensitivity to heat and light, and weight loss. His blood tests showed an elevated thyroid stimulating hormone level. Based on his symptoms and test results, it is suspected that he may have Hashimoto's thyroiditis, an autoimmune disease where the thyroid is initially overactive before becoming underactive. Further tests are needed to confirm the diagnosis.

1. Mr. Singh
Presented by:

2. Case Study ( Mr. Singh)
Mr. Singh was in the general ward and presented
as feeling irritable, forgetting things, and being
sensitive to heat and light. Mr. Singh has a history
of diverticular (small sacks on the colon wall) but
he manages it well with food intake. On
examination, the doctor found that he has bulging
eyes, has lost weight in the last few months and
his hair is dry and brittle. The doctor suggested
further investigations and bloods were ordered.
His observations were:
Temperature 36.5o centgrade
Pulse 76
Blood pressure 125 / 70
Respiratory 18
Saturation rate 96% RA

3. Contd……
Biochemistry Mr. Singh 10/ 06/1953 UR 2228
Reading Range
Haemoglobin 144g/L (120-160 female; 140- 170g/L males)
Thyroid stimulating hormone 70miU/L (0.4-40MiU/L)
White blood count 6g/L 4.0-11x109/L
Platelet count 1559/L (150-400x109/L)
Red blood cells 5 (4.5-6.5x129/L)
Blood sugar 4 (4-8mmol/L)
Neutrophils 2.0 (2.0-7.5x109/L)
Lymphocytes 1.5 (1.5-4.0x109/L)
Monocytes 0.3 (0.2-0.8x109/L)
Eosinophils0.04 (0.04-0.4x109/L)
Basophils 0.01 (0.01x109/L)

4. Q/A
1. From the blood work undertaken what do think
Mr. Singh is suffering from?
 Symptoms suggest a thyroid-related condition.
 High TSH levels typically indicate hypothyroidism,
but symptoms align more with hyperthyroidism.
 A possible condition could be Hashimoto’s
thyroiditis, an autoimmune disease that initially
causes hyperthyroidism followed by hypothyroidism
as well as exhibiting stromal fibrosis and follicular
cell destruction due to lymphoplasmacytic
infiltration

5. Contd……

6. Q/A
2. What other tests or investigations should be undertaken to
diagnose Mr. Singh properly?
 Free thyroxine (T4) Test – Measures the level of free T4 in the
blood assess thyroid function.
 Anti-thyroid Antibody test – Check for autoimmune thyroid
diseases such as Hashimoto’s thyroiditis or Graves disease.
 Thyroid Ultrasound – Helps visualize the thyroid gland and
detect any structural abnormalities by enabling precise
morphological assessments and the ability to measure the sizes
of organs and lesions in detail.".
 Thyroid Scan – A radioactive scan or technetium scan provides
information about the function and activity of the thyroid gland.

7. Contd…..
 Complete Metabolic Panel (CMP) – Assesses overall
health, including electrolyte levels, kidney and liver
function, and blood glucose levels.
 Lipid Profile – Checks cholesterol and triglyceride
levels, as thyroid disorders can affect lipid metabolism.
 Additional Blood Tests – Check for other potential
causes of symptoms, such as anemia, vitamin
deficiencies or autoimmune disorders
 Imaging – Additional imaging studies like CT scans or
MRI may be recommended to evaluate any possible
structural issues related to the symptoms.

8. Q/A
3. Mr. Singh is irratable as a nurse how do you manage
him?
 Understand Mr. Singh - His irritability might be due to his
health issues. Let him know you’re there to help.
 Talk Calmly - Use a soft voice and listen to his concerns by
effective communication.
 Include Him - Let Mr. Singh be part of care decisions to
make him feel in control.
 Distract Him - Use music, TV, or books to help him relax.
 Keep Him Comfortable - Check his comfort regularly - like
bedding and room temperature.
 Ask for Help - If needed, get support from your team.

9.  Assess Pain and Discomfort: Irritability may be a result of physical discomfort or pain. Assess Mr.
Singh's physical condition to ensure there are no underlying issues that need immediate attention.
Once you have a better understanding of his concerns, work together to address them. Offer solutions
or suggestions that can help alleviate the issues he's facing.
 Stay Calm and Patient: It's essential to remain calm and patient when dealing with an irritable patient.
Don't take his irritability personally and maintain a compassionate and empathetic attitude.
 By identifying triggers and try to resolve them plays an important role, elimination of hazards that
can cause patients harms. Communication, empathy, and a focus on his comfort and care are key
elements of your role as a nurse.

10. Q/A
4. How did you come up with the diagnosis result?
Based on Mr. Singh’s symptoms like feeling hot, losing
weight, having bulging eyes, and dry hair, along with his
high Thyroid Stimulating Hormone (TSH) level from his
blood test, it seems like he might have a thyroid problem.
His symptoms are usually seen in hyperthyroidism
(overactive thyroid), but his high TSH level is usually seen
in hypothyroidism (underactive thyroid). This mix-up could
be due to a condition called Hashimoto’s thyroiditis, which
can first cause hyperthyroidism and then lead to
hypothyroidism. But remember, this is just a guess. A
doctor needs to do more tests to make sure.

11. References
Department of Health & Human Services. (2007, June 8). Thyroid - Hashimoto’s disease. Better Health Channel.
https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/thyroid-hashimotos-disease
Healthdirect. (2023, March 10). Thyroid function tests. Healthdirect.
https://www.healthdirect.gov.au/thyroid-function-tests
Nakazawa, A., Iwamoto, M., Kurazume, R., Nunoi, M., Kobayashi, M., & Honda, M. (2023). Augmented reality-based affective training
for improving care communication skill and empathy. PLoS One, 18(7)
https://doi.org/10.1371/journal.pone.0288175
Seifert, P., Sophie-Luise Ullrich, Kühnel, C., Falk Gühne, Drescher, R., Winkens, T., & Freesmeyer, M. (2023). Optimization of Thyroid
Volume Determination by Stitched 3D-Ultrasound Data Sets in Patients with Structural Thyroid Disease. Biomedicines, 11(2), 381.
https://doi.org/10.3390/biomedicines11020381