Question

ENDOCRINE CASE STUDY Make sure to use APA format, use in-text citations and appropriate references. Answer each question fully and completely: each question and answer should stand on its own. An otherwise healthy thirty-eight-year-old woman presents with eight months of feeling anxious and tremulous. She reports having experienced intolerance to heat, weight loss, weakness and palpitations. On exam her pulse is 118 and blood pressure is 160/88 mmHg. She had a mild lid lag, a moderately enlarged, non-tender thyroid, and hyperreflexia. Laboratory tests were remarkable for elevated titers of thyroid stimulating immunoglobulins (TSI) and depressed TSH levels (<0.1mU/ml). She is treated with propranolol and thionamides (propylthiouracil (PTU) and considered for radioactive iodine (RAI 111) therapy. 1. Draw a feedback loop to illustrate how thyroid hormone (TH) release is regulated in the normal patient. Explain what is different in our patient. 2. What are the general functions of TH in the body? Briefly explain our patient's symptoms based upon your prediction about her TH levels. What is lid lag? 3. Given the decreased levels of TSH, and increased TSI, what would you predict our patient's level of TH would be and why? 4. What kind (steroid, peptide et cetera) of hormone is TH? How is it transported in the blood? Where does it bind its receptor? What is the target cell response (second messenger activation or transcriptional activation)? 5. How does the increased levels of TSI contribute to hyperthyroidism? Is TSI functioning as an agonist or an antagonist? Explain your answer. 6. Why is our patient given propranolol? What symptoms would this alleviate and why? 7. Thioamides inhibit TH synthesis. Would this benefit our patient? Why or why not? 8. If our patient undergoes treatment with RAI 1311, what would you expect to happen to her TH levels and why? 9. Discuss the mechanism of Action for Methimazole 10. Discuss the 4 Therapeutic Uses for Methimazole 11. Agranulocytosis is a dangerous adverse effect of Methimazole. How is it detected. What education would you provide to your patient related to agranulocytosis. 12. After treatment with RAI, the patient TSH is 6 mU/ml. The patient presents with signs and symptoms of hypothyroidism; why might this be? 13. Discuss the pharmacokinetics related to Levothyroxine. 14. Discuss the nursing implications and interventions related to the administration of warfarin with Levothyroxine. Which lab studies are necessary?

Answer 1

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