CASE STUDY

Read the following case study and answer the posed questions:

Case #1:

History: A 65 year old housewife complains of progressive weight gain of 40 pounds in 1 year, fatigue, dizziness, sluggish memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.

Physical examination: Vital signs: temperature 96.4oF, pulse 68/minute and regular, BP 108/60, weight 170 lbs, height 5 feet, puffy face, pale, cool, dry skin. The thyroid gland is not palpable, deep tendon reflex time is delayed.

Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.4 ug/dl (N=4.5-12.5), the serum TSH is 0.9 uU/ml (N=0.2-3.5), and the serum cholesterol is 275 mg/dl (N<200).

  1. What is the likely diagnosis and what symptoms made you consider that diagnosis?
  2. Which lab data supported the diagnosis?
  3. Explain-Hypothalamic-Pituitary-Thyroid axis and interrelationship.

Case #2:

J.R. is a 58-year old man who presented with a 6-week history of polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed on day of his visit and was 359 mg/dl. The patient denied any symptoms of numbness, tingling in hands or feet, dysuria, chest pain, cough or fevers. He had no prior history of diabetes and no family history of diabetes.

Admission non-fasting serum glucose 268 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-6.1%). Electrolytes, BUN and creatinine were normal. Physical examination revealed weight of 190 pounds, height 5’6.5″ . The rest of the examination was unremarkable, i.e., no signs of retinopathy or neuropathy.

  1. What are the mechanisms of blurred vision which was part of his initial symptoms?
  2. Are there correlations between his abnormal blood chemistries and his other symptoms?
  3. Identify the cardiovascular and microvascular risk factors in the history, physical examination, and laboratory data in this patient.

Cite current research findings, national guidelines, and expert opinions and controversies found in the medical and nursing literature to support your position.

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