Diseases Based on Physiological Changes Seen with Normal Thyroid Physiology - Coursework Example

Clinical Sciences Table of Contents Clinical Sciences Table of Contents 2 A. Contrast The Altered Physiological Changes Seen With Normal Thyroid Physiology. 3 B. Based On Your Understanding Of The Changes Seen In This Woman What Would Be Your Differential Diagnosis? 4 C. What Complications Could Occur If This Swelling Increased In Size? 6 D. What Other Investigations Could You Carry Out To Confirm Your Diagnosis? Describe Three Of Them And Give Reasons For Your Choice. 9 References 12 A. Contrast The Altered Physiological Changes Seen With Normal Thyroid Physiology. As per the scenario of the case, a 78-year old woman is suffering from asymptomatic thyroid swelling as a result of which there are certain physiological changes that are being identified in the woman. In this section, discussion will be made regarding the difference in physiological changes in a person between the asymptomatic thyroid and normal thyroid. However, the asymptomatic thyroid is generally known as hypothyroidism and it does not show noticeable symptoms mainly among the older adults in the early stage (Bar & et. al., 2007). Even the person bearing this disease cannot understand any changes or symptoms within him/her. The disease can only be revealed through blood tests and other thyroid tests. However, if hypothyroidism is not treated and is neglected the symptoms start getting noticeable and situation gets worse (Adair & et. al., 2008). There are certain symptoms of hypothyroidism that may be noticeable within a person if not treated at the right time. These includes, weight gain, depression, low energy levels, slow thinking, constipation, muscle weakness, tenderness, aches, pain, swelling of joints, swelling of face, pale dry skin and high sensitivity to cold among others (Penn State Hershey, 2011). It is very essential to treat hypothyroidism in right time because neglecting it, may cause various serious health related issues such as, the enlargement of the thyroid gland that creates difficulty for a person to swallow or breathe. If the disease in not treated or is neglected, there increases the risk of various heart diseases, enlargement of heart or even heart attack (Health in Aging, 2015). Moreover, it may also cause the loss of control over muscles or damage the nerves. In this regard, not treating the hypothyroidism for long time may lead to a fatal complication among individuals, which is known as “Myxedema Coma”. The common signs include low blood pressure, low blood sugar, low body temperature, unresponsiveness and shallow breathing (Steinberg, 2008; NIDDK, 2015). On the other hand, the symptoms and characteristics of normal thyroid are quite different from that of the hypothyroidism. Unlike hypothyroidism, the symptoms of normal thyroid are easily identifiable. Normal thyroid affect the people of any age group irrespective of gender. However, the symptoms of this disease are largely prevalent among the females and the symptoms of this disease include excess tiredness, loss of hair and gaining excess weight (Medicine Net, 2015). Other common symptoms of normal thyroid include hypertension and excess sweating. Therefore, it is essential to treat the disease in correct time in order to prevent the risk of long-term health related issues and other physiological disorders. Lower presence of thyroid may result in the unexpected weight gain and vice versa. Thyroid may cause loss of hair in an individual both due to higher presence and due to lower presence of the thyroid hormones. Curing the disease in the right time is very essential in order to prevent future health related problems. Thyroid is considered as hereditary and there is a huge possibility of an individual being affected by the disease if any of his/her ancestors were affected by thyroid (WebMD UK Limited and Boots UK Limited, 2014). B. Based On Your Understanding Of The Changes Seen In This Woman What Would Be Your Differential Diagnosis? As per the scenario of the case, it can be seen that the 78- year old woman with the asymptotic thyroid swelling conducted a blood analysis that revealed her TSH concentration level on her blood. The TSH concentration level was 37mlU/L whereas the serum free thyroxin was 5.4pm/L, which represents that the presence of the thyroid hormone level in the woman is much higher than that of the normal level of hormone that should be present. Moreover, ultrasonography of the neck was also done that revealed the diffused hypo echoic enlargement of the thyroid gland without any retrosternal enlargement. However, as per the physiological changes recognized in the woman, there may be some other methods of diagnosis that may be implemented for treating the hyperthyroidism in the woman. Before that, it is essential to understand the present condition of the woman and thus blood analysis should be conducted again in order to reconfirm the result (1Vertical Health LLC, 2015). The blood test would help in understanding the current levels of TSH and thyroxin in the blood of the woman. If the level of thyroxin is either high or low or even if there does not exist, any trace of TSH in the blood, it represents an overactive thyroid (NHS, 2015). Blood test is considered as most important especially for the old adults within whom there does not exists any symptoms of hyperthyroidism (American Academy of Family Physicians, 2015). However, if the reports of the blood test reveal that the woman has hyperthyroidism, therefore in order to determine that the thyroid is overactive or not, the ‘Radio-active iodine uptake test’ must be conducted (1Mayo Foundation for Medical Education and Research). ‘Radio-active iodine uptake test’ is considered as one of the best diagnosis methods of hyperthyroidism. The test would be conducted by asking the woman to take an oral dose of the radioactive iodine and over time, it will be collected in the thyroid gland as the thyroid makes use of the iodine for manufacturing hormones. The woman would be checked after every 24 hours in order to identify the amount of iodine that the gland has absorbed (WebMD, LLC, 2015). High uptake of the radioactive iodine represents that the thyroid gland of the woman is generating higher amount of thyroxin (Mayo Foundation for Medical Education and Research). If the report of the result is positive, the hyperthyroidism may be treated with the help of Antithyroid Drugs. These drugs intervene with the organifications of the iodine and thus suppress the hormone levels of the thyroid (Milas, 2015). Two most effective anti-thyroid drugs that may be used for the treatment includes Methimazole and Propylthiouracil (Graves Disease & Thyroid Foundation, 2015). However, both the medicines have fewer side effects and the compositions are safe for the older adults. Using the antithyroid medicines can lead to a normal TSH level as well as the thyroxin level within the woman. However, it is very essential to monitor the woman properly during the treatment for the first three months in order to analyze the effectiveness of the diagnosis that will help in deciding for the future diagnosis. In case if the current diagnosis does not work, some alternative diagnosis methods for hyperthyroidism may be implemented that would serve effective for eradicating the disease. However, for normal thyroid the diagnosis is more or less similar as the patient needs to undertake a blood test along with Imaging tests rather than going for radio-active iodine tests (UpToDate, Inc, 2015). C. What Complications Could Occur If This Swelling Increased In Size? As per the initial tests of the woman, it was revealed through ultrasonography that the neck had a diffused hypo-echoic enlargement of the thyroid gland with no retrosternal enlargement (2Vertical Health LLC, 2015). This represents that the swelling of the thyroid gland of the woman was not much severe. However, if in case the swelling of the thyroid gland increases in size, there are certain complications that may arise within the woman, which includes: Difficulty in berating and swallowing Heart Problems Eye problems Mental Health issues Brittle Bones Tumor However, the increase in the swelling of the thyroid gland may cause difficulty for the patient in breathing as well as swallowing food. A thyroid gland is generally located at the front covering the side of the neck in the form of butterfly (2Mayo Foundation for Medical Education and Research, 2015). Therefore, if the thyroid gland is enlarged it will create obstruction for any food matters or water to enter through the throat and thus it will cause severe pain while swallowing food or drinking water. Similarly, in case of breathing obstruction will be created due to the swelling of throat that will create difficulty for the air to enter the lungs and breathe through (Demand Media, Inc, 2015). The symptoms of the swelling of thyroid gland due to hyperthyroidism are closely interlinked with each other. The breathing problem due to swollen throat creates difficulty to breathe and thus insufficient oxygen reaches the body. This may result in heart problem, which is one of the most serious and the dangerous complications that may occur (Cleveland Clinic, 2014). The symptom includes rapid beating of the heart, rhythmic disorder of the heart and even congestive heart failure, which is considered as the condition when the heart fails to circulate the required amount of blood needed by various parts of the body (1Mayo Foundation for Medical Education and Research, 2015). As the swollen increases, it represents that the hyperthyroidism is also increasing within patient and thus it may even result to severe eye problems (AAPOS, 2015). The high or low secretion of the thyroxin hormones affects the tissues of the eyes negatively and thus may result to swollen or red eyes, blurring, double vision or even highly sensitive to lights. It is thus essential to treat the disease in time in order to prevent from the loss of vision. Similarly, the brittleness of the bones can also occur as a result of increased hyperthyroidism that is being revealed through the swelling of the thyroid gland (Associated Newspaper Limited, 2012). The strengths of the bones are completely dependent on calcium as well as mineral content in the blood. High release of the thyroid hormones interferes with the calcium and minerals of the body and thus prevents them in incorporating into the bones and thus makes the bones brittle (1Mayo Foundation for Medical Education and Research, 2015). As discussed earlier that the symptoms of the hyperthyroidism are interlinked with each other. Thus, one of the most important identified complications due to swelling is also related with the mental health of the patient. Due to the various health related complications, it may create depression within the patient, which may result in an unstable mental state for patient (1Thyroid Foundation of Canada, 2015). Moreover, the excessive swelling of the thyroid gland if kept untreated for long time, it may lead to tumor. If the tumor exists for long time, it may even cause thyroid cancer, which may even take the life of the patient. Therefore, it is inherently necessary to treat the swelling in time in order to be away from the life taking danger (Cleveland Clinic, 2014). D. What Other Investigations Could You Carry Out To Confirm Your Diagnosis? Describe Three Of Them And Give Reasons For Your Choice. There are various diagnosis carried out for hyperthyroidism within woman and various investigations have been conducted in order to understand the effectiveness of the diagnosis. Besides these, there are also some other investigations that may be carried out in order to confirm the diagnosis (2Thyroid Foundation of Canada, 2015). These include measurement of the TSH, Thyroid Biopsy and Thyroid Imaging. Measurement of the TSH Measuring the level of TSH in the patient’s body would help in understanding the extent to which the treatment is effective to patient. TSH is a pituitary hormone and it stimulates the thyroid gland in releasing various thyroid hormones. The rise in the TSH level indicates the decrease in thyroid hormone levels. Therefore, with the help of proper and an effective TSH examination it can be analyzed whether the diagnosis is effective in reducing hyperthyroidism within woman. Moreover, it will also help in planning for the future diagnosis of the disease and the necessary alterations are necessary for the diagnosis (Quest Diagnostics Incorporated, 2014). Thyroid Biopsy Thyroid biopsy may be considered as one of the major forms of investigation that would help in confirming the diagnosis. In this analysis, a small needle is inserted into the thyroid gland and the thyroid cells are drawn out which are being tested. This helps in understanding the extent to which the thyroid disease is existing within patient. However, the process is not much painful and there does not exist, any risk of thyroid cancer after the biopsy is done. Thus, thyroid biopsy also helps in analyzing the effectiveness of the diagnosis within patient (Radiological Society of North America, Inc, 2015.). Thyroid Imaging Finally, thyroid imaging would also serve as the effective means to confirm the diagnosis. Ultrasound may be used for performing the thyroid imaging, which is very perceptive and provides in-depth information regarding the shape and size of the thyroid glands as well as nodules. Moreover, MRI and CT scans also serve as the effective means of analysis but they do not provide clear information regarding the extent of growth rate or the rate of recovery (Indian Journal of Endocrinology and Metabolism, 2010). However, in addition to the above-mentioned investigations, the effectiveness of the diagnosis may also be confirmed by analyzing properly the symptoms within patient. If the diagnosis is effective, the symptoms of hyperthyroidism will start reducing or eliminating. Feedback from the patient may also be taken into consideration that will help in understanding whether there is any change after the diagnosis. References AAPOS, 2015. Thyroid Eye Disorders. Article. [Online] Available at: http://www.aapos.org/terms/conditions/105 [Accessed March 09, 2015]. Adair, C. F. & et. al., 2008. Enlarged Thyroid Gland with Normal Thyroid Function Tests. Journal. [Online] Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277353/ [Accessed March 09, 2015]. 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Complications of Hypothyroidism. Article. [Online] Available at: http://www.endocrineweb.com/conditions/hypothyroidism/complications-hypothyroidism [Accessed March 09, 2015]. Read More