PATHOPHYSIOLOGY

Pathophysiology of Disease



Pathophysiology of Disease

Introduction

This assignment is intended to learn about pathophysiology of disease. This is a case study relating to a 25-year-old female patient who was presented for intolerance to heat and exhaustion. The patient wa found to have exophthalmos with a goiter which was obvious. There was a btuit identified with auscultation of thyroid gland. The paptient was also detected with marked tachycardia (initially 110/min) but without any extra sounds. There was found to be some uterine enlargement along with the negative results of abdominal examination. It was also told that the patient was pregnant having a weight of 93kg with BP of 152/88 and 84bpm heart rate. There was also a presence of exophthalmos was present with slight conjunctival oedema. Extraocular movements were intact. Skin was moist, and thyroid palpable and diffusely enlarged. Bilateral leg oedema noted.

Analysis of the Results

Question 1: What is the diagnosis? How do the thyroid function tests relate to the diagnosis?

The paptient under study is diagnosed with exophthalmos. Exophthalmos s a protruding eyeball anteriorly out of the orbit (eye socket). The Greek word ophthalmos means "eye" and the Greek word ex means "out". Exophthalmos can be either bilateral (both eyes bulge out) or unilateral (just one eye bulges out). Doctors use an exophthalmometer to measure the degree of exophthalmos. Depending on the severity of the exophthalmos, if it is left untreated the eye lids may fail to close during sleep, resulting in corneal dryness and eventual damage. People with exophthalmos also risk developing superior limbic keratoconjunctivitis, where the area above the cornea becomes inflamed because of the friction that occurs when the patient blinks. Some patients may experience compression of the optic nerve or ophthalmic artery, which can eventually affect the patient's eyesight, leading to blindness.

Question 2: Are the available test results sufficient to confirm the diagnosis? Suggest the clinical usefulness of T3 determination. Is a request for TSH determination indicated? What TSH value do you expect?

From the given results, it is clear that all the values of T4, FT4 and T3 exceeds their acceptable limits. Thus we can say that thyroid function test results are not sufficient for this diagnosis. Eye showed eyelid edema, retraction and late fall, conjunctival hyperemia, eye to the front of the prominent, radial deviation and then blink reflex movement reduced. Imaging showed enlargement of extraocular muscle symmetry, especially when the coronal CT scan more apparent. Serum T3, T4, TSH and T3 inhibited the determination of test and TRH test will help diagnosis of endocrine exophthalmos. (Lake , 2003, 17)

Because bilateral exophthalmos is usually due to hyperthyroidism, thyroid profile should be done. The most useful in this profile are the level of total T4 by immunoassay of free thyroxine index, and radioactive iodine (RAI), the capture and analysis. A total of triiodothyronine (T3), immunoassay test should be done to exclude T3 thyrotoxicosis. Because bilateral exophthalmos may occur without hyperthyroidism, evidence of TSH receptor antibodies and thyroid peroxidase antibodies should be done if thyroid function tests are negative ...