Endocrine Case Histories - Case 26

A 30-year-old female demonstrated a subtle onset of the following symptoms: dull facial expression; droopy eyelids; puffiness of the face and periorbital swelling; sparse, dry hair; dry, scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (hematocrit 27); enlarged heart (upon radiological exam); constipation, and hypothermia. Plasma concentrations of total and free T4 and T3 follow: Free Radioimmunoassay (RIA) of peripheral blood indicated elevated TSH levels. A TSH stimulation test did not increase the output of thyroid hormones from the thyroid gland.

1. What endocrine organ is involved here?

2. Is this a primary or secondary disorder? Why? (Is a TSH or TRH determination necessary for your diagnosis?)

3. Describe the feedback loop involved, indicating if there is an increased or decreased TSH level.

4. List several defects that could cause these symptoms.

5. Would you expect to find a palpable goiter? Explain your answer.

6. Describe a suitable treatment for this individual.

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T4	T3
Total	3.0 µg/dL	0.14 ng/dL
0.6 ng/dL	0.01 ng/dL