SON4010 - Embryology Anatomy and Pathophysiology - Thyroid - Interrupted Case Study Assignment Help

SON4010: Embryology Anatomy and Pathophysiology Thyroid Interrupted Case Study Assignment Help

Assignment Task:

Task 3 Assignment: Interrupted Case Study-Thyroid

Part I – Initial patient presentation
You are six months into your ultrasound training program and so far, you have had a great experience with Elouise the tutor Sonographer, but you have only seen a limited number of patients with thyroid pathology. Today, you will shadow Louise as she performs an ultrasound on Angela, a patient who was referred by her G.P. While waiting, you pull up Angela’s information on the computer and you find that she is a 54-year-old woman who has recently immigrated from China and has no previous health issues. Angela arrives at the clinic and you accompany Elouise into the ultrasound room to get Angela’s history. She asks Angela to elaborate on what has been bothering her. Angela says that she has been cold, tired, fatigued, and just not feeling up to her normal activities. She has also gained roughly 7 kilos even though she has been consciously monitoring her food intake. Angela can’t understand what is wrong—she went through menopause 2 years ago, but she insists that the way
she is feeling is not related to that change; she also has not changed anything else about her normal routine.
The G.P has told Angela that she suspects a thyroid issue and has ordered some blood tests and a thyroid ultrasound. Angela asks about the thyroid and why it is important. Louise asks you to help explain this hormone system to the patient.

Questions
1. Using a diagram briefly explain the hypothalamic-pituitary-thyroid axis. Make sure to include the feedback loops and spell out the hormone names.

2. What is the physiological role of thyroid hormones? Does T3 or T4 play a larger role on the target tissues? Explain.

Part II – Ultrasound Examination

You observe Elouise perform the ultrasound examination. As you have limited experience with this procedure you struggle to interpret the images. You note that Elouise seems to be doing a lot of measurements of the thyroid gland.
Questions
3. Describe the anatomy and function of the normal thyroid gland including size, shape and position in relation to surrounding structures. Include in your answer the role of the follicular and parafollicular cells.

4. Using your knowledge of anatomy as described above; what are the localised physical symptoms that a patient may experience if the thyroid is enlarged, i.e. which structures may be affected?

Part III– Research
The G.P has told Angela that her test results will be back in a few days and that she will give her a call
when she knows something. You go home and do some research on various thyroid conditions so
that you’ll have a good idea of what is going on with Angela. You find information on
hyperthyroidism, hypothyroidism, goitre, Graves’ Disease, iodine deficiency (primary
hypothyroidism), Hashimoto’s thyroiditis, and various tumours.

Questions
5. Compare hyperthyroidism and hypothyroidism. Include the main aetiology for each and list at least three symptoms for each condition.

6. What is a goitre?

7. Describe two different scenarios/conditions in which a goitre would be present and explain physiologically why/how the goitre occurs within each scenario/condition.

8. Enlargement of the thyroid gland may also be due to the presence of a single mass or nodule. Discuss the likely differentials for a discrete, solitary mass/nodule occurring in a patient of Angela’s age and gender.

Questions

9. Do the blood tests indicate that Angela has symptoms consistent with hypothyroidism or
hyperthyroidism? Justify your response. (5)

Part V – Diagnosis
Angela returns to the G.P for her test results and Louise asks you to follow up this case and find out the final diagnosis for Angela. You begin with checking the radiologists report of her thyroid ultrasound. Radiologist Report Thyroid ultrasound: Angela Barber

The thyroid gland is diffusely enlarged with a heterogenous texture. There is evidence of a pseudo- nodular pattern/presence of micronodules with surrounding echogenic septations. Colour Doppler examination indicates hypervascularity. Two prominent reactive lymph nodes are visualised with the
largest being 1.5cm. This appearance is highly suggestive of Hashimoto’s thyroiditis.
.

Questions
10. Is the radiology report in accordance with Angela’s presenting symptoms? What specifically supports your answer?

Part VI – Conclusion
Angela returns to her G.P for her test results. The G.P. confirms that her blood tests and thyroid ultrasound indicate that she has Hashimoto’s thyroiditis and she decides to treat Angela with thyroid hormone therapy. This should alleviate her presenting symptoms. Her blood tests and thyroid gland will need to be monitored regularly to check for any changes to her condition.

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