Dear writer please follow instructions for assignment below. I have included Adria response to use for this assignment.
Peer Response
Instructions:
Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least three of these prompts:
Do you agree with your peers’ diagnosis?
Take an opposing view to a peer and present an alternative approach.
Share your thoughts on how you support their opinion and explain why.
Present new references that support your opinions.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please review the rubric to ensure that your response meets the criteria.
Adria Respone
What is the likely diagnosis and what symptoms made you consider that diagnosis?
Based on the symptoms described, it seems likely that this patient is suffering from a condition called hypothyroidism. This is the most common disorder of the thyroid gland and is seen more in woman than men (McCance & Huether, 2019, p. 676). The primary symptoms of rapid weight gain, puffy face and cold intolerance were what led me to this conclusion of hypothyroidism as those are tell-tale signs. Further, slow speech is a neurological symptom associated with this disease as well that is due to poor cerebral blood flow (McCance & Huether, 2019, p. 679). Bradycardia can be associated with hypothyroidism; however, this patient does not display that feature.
Which lab data supported the diagnosis?
In order to formally diagnosis hypothyroidism, the provider will order labs to evaluate. With hypothyroidism, there are different forms that can arise. In primary hypothyroidism, thyroid stimulating hormone, or TSH, will typically be increased while TH (T3 and T4) will show decreased levels (McCance & Huether, 2019, p. 679). For this patient, TH shown through T4 is 3.4 which is less than the expected range. However, the TSH level in this patient is 0.9 which is within the range. These labs do not support the diagnosis of primary hypothyroidism which leads the differential to other forms. This patient has lab levels consistent with hypothyroidism caused by pituitary gland deficiencies. A normal TSH and decreased TH, exemplified through the T4 level, support this diagnosis. The thyroid also regulates cholesterol through the hormone called thyroxine (Kotwal et al., 2020). When hypothyroidism is present, such as this case, there is not enough of the thyroxine available to control cholesterol levels, which can lead to the elevated cholesterol level of 275.
Explain Hypothalamic-Pituitary-Thyroid axis and interrelationship.
The Hypothalamic-Pituitary-Thyroid axis, or HPT, helps regulate thyroid function and hormones. The ability for the thyroid to work properly can depend on the pituitary glycoprotein TSH. When the pituitary is not secreting or functioning well, this can lead to hypothyroidism due to the absence of hormones (Mariotti & Beck-Peccoz, 2021). With a lack of thyroid hormone regulation from the pituitary gland, the T3 and T4 that are secreted from the thyroid will decrease in turn.
Case Study #2
What are the mechanisms of blurred vision which was part of his initial symptoms?
Blurred vision is a complication that occurs with diabetes. Water levels in the eye can change depending on glucose levels (McCance & Huether, 2019, p. 689). Hyperglycemia leads to osmotic change causing the lenses of the eye to fill with fluid. This leads to blurry vision and eventually can cause diabetic retinopathy, which can be a factor in permanent blindness.
Are there correlations between his abnormal blood chemistries and his other symptoms?
The lab values listed such as a random glucose of 359 and an elevated HbA1C at 9.1 correlate with the symptoms of diabetes. Polyuria, polydipsia, and polyphagia are the classic signs of diabetes. HbA1C measures the frequency of hyperglycemia occurring over the past 2-3 months. With the elevation in this lab, it points to uncontrolled glucose levels, once again supporting the diagnosis of diabetes.
Identify the cardiovascular and microvascular risk factors in the history, physical examination, and laboratory data in this patient.
This patient is at risk for complications associated with diabetes from numerous factors. Diabetes itself can cause microvascular changes to the kidneys, eyes, and nerves from glucose toxicity, or chronic hyperglycemia (McCance & Huether, 2019, p. 692). Luckily, this patient denied any neuropathy, or tingling, in the limbs which is a sign of worsening disease. In order to prevent these complications, along with cardiovascular complications, the patient needs to have strict glucose maintenance. Kidney disease is common in over 50% of diabetes patients due to chronic hyperglycemia causing hyperperfusion (McCance & Huether, 2019, p. 697). These changes can lead to glomerular changes and thickening of kidney membranes, causing hypertension and renal failure. As discussed in previous units, hypertension plays a role in cardiovascular risk and puts the patient at a higher chance of having a myocardial infarction and congestive heart failure.
References
Kotwal, A., Cortes, T., Genere, N., Hamidi, O., Jasim, S., Newman, C. B., Prokop, L. J., Murad, M. H., & Alahdab, F. (2020). Treatment of Thyroid Dysfunction and Serum Lipids: A Systematic Review and Meta-analysis. The Journal of clinical endocrinology and metabolism, 105(12), dgaa672. https://doi.org/10.1210/clinem/dgaa672 Links to an external site.
Mariotti S, Beck-Peccoz P. (2021). Physiology of the Hypothalamic-Pituitary-Thyroid Axis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278958/
McCance, K. & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children. 7th Edition. Elsevier Mosby: St. Louis, MO. ISBN: 978-0323088541.
