Josh Ho 3/12/12 TA: Gregory Deiulio Case Report

At the age of 21 years old our patient Janet Stone began to feel an increase in sense of nervousness, heart palpitations, inability to tolerate heat, and gradual loss of weight despite having a good appetite. A highly active individual who used to jog 10 miles a week suddenly doesnt feel up for it anymore, she feels fatigued and seems to have problems with her legs. In this case study, our patient Janet will be examined and diagnosed. Our first hypothesis was hyperthyroidism. We started with the basics by asking if her family had any kinds of medical history with regards to thyroid. Janet reported that she did not in fact have any knowledge. The next question we asked was what the palpitations felt like. She responded to have a sense that her heart would often beat hard on the top of her chest, lasting only 10 seconds then disappearing. Lastly we asked her if she was tired frequently and she responded saying that her legs often gave up when she walked up and down the stairs. She uses a beanbag in her room as a chair and often finds it hard to get up after sitting down. We began treatment and first wanted to test the thyroid level. Sure enough our patient exhibited higher amounts of thyroid then usual. Janets T3 (triiodothyronine) was around 510 ng/dl which was higher then the average. These numbers proved to be highly significant because it showed signs of abnormality leading us to start to question and to keep our current hypothesis. By testing the thyroid-stimulating hormone we noticed an overproduction of thyroid. This

dramatic increase in the production of thyroid may have been the reason why our patient was exhibiting these side effects. Our second hypothesis was graves disease. We noticed that there was a overproduction in thyroid levels in our patients body. Hyperthyroidism can be traced all the way back to Graves disease. By measuring our thyroid stimulating hormone, T3, and T4 we noticed that there was a overproduction. This might have lead to some of the causes of fatigue, heat flashes, and weariness. Graves disease is most common among women before they hit the age of 40 and is often nonthreatening. By running tests and treatment our patient started getting better. The solution was prescribing beta-blockers in order to inhibit the production of thyroid hormones. This caused a decrease and a relief of symptoms commonly occurring in those who have graves disease. Our third hypothesis was Chronic Fatigue Syndrome. We were lead to this belief due to her legs weakening and constantly giving out. Furthermore, this also explained the heat flashes and the increase in appetite. We ran a heart examination and found everything to be perfectly normal. Our echocardiogram showed signs of normal valve function which lead us to believe that the heart of functioning in normal conditions. A sweat test was then run in order further prove this hypothesis but was quickly ruled out because her sweat levels we 14mmol/L, which was perfectly acceptable and normal. Chronic Fatigue Syndrome was quickly ruled out of hypothesis. In the end, Hyperthyroidism and Graves Disease stood out and seemed the most plausible explanation with respect to our patient. Our patient we concluded

had no life threatening disease. A prescription that inhibits the production of thyroid (beta blocker) would work because it not only blocks the production of thyroid but also the side effects are barely noticeable. What we can also recommend is that the patient to go through a radioactive iodine treatment in which thyroid cells absorb radioactive iodine and are damage and ultimately killed. There is very little known side affects and this process takes about one to two months. The only known side affect is under activity of thyroid gland. These are the optional treatments available for our patient and this concludes our diagnostics test for our patient Janet Stone.

Sources Used: Norman, James. "Hyperthyroidism: Overactivity of the Thyroid Gland." Treatment of Hyperthyroidism: Drugs, Iodine, and Surgery as Treatments for Hyperthyroid Problems. 13 Oct. 2010. Web. 13 Mar. 2012. http://www.endocrineweb.com/conditions/hyperthyroidism/hyperthyroidismoveractivity-thyroid-gland. "Graves' Disease Fact Sheet." Womenshealth.gov. Ed. David Cooper. 18 May 2010. Web. 13 Mar. 2012. http://www.womenshealth.gov/publications/our-publications/factsheet/graves-disease.cfm "Chronic Fatigue Syndrome: MedlinePlus." U.S National Library of Medicine. U.S. National Library of Medicine. Web. 13 Mar. 2012. http://www.nlm.nih.gov/medlineplus/chronicfatiguesyndrome.html