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Case Study

Bertha is a 71-year-old woman who takes daily medication for Hashimoto thyroiditis. Last winter, she developed pneumonia. Although she did her best to run errands for her husband, she tired easily and needed to rest frequently. One day, after shoveling the snow outside, her husband came inside to find Bertha lying on the sofa covered in blankets. Her face appeared puffy and her eyelids hung. When he spoke to her, Bertha’s voice was hoarse, and her words didn’t make sense to him. Her respirations were also shallow and slow. Suspecting low thyroid hormone levels were causing the signs, her husband called for an ambulance.

Question 1

When testing for hypothyroidism, why is the free T4 level an important measurement? Predict what the TSH and T4 test results would indicate in someone with primary hypothyroidism. Explain your answer

Question 2

Using your knowledge of the function of thyroid hormone in the body, explain why Bertha’s

rate was decreased. Why might pleural effusion be present in someone with hypothyroidism?

Question3

What factors in Bertha’s history leave her susceptible to myxedema coma? Describe the physiologic aspects involved in myxedema coma.