Case Study- Hot Flushes

Menopause- hot flushes, night sweats, sleep disturbance, vaginal dryness and discomfort.

Monitoring of Hypothyroidism

Symptomatic improvement occurs in 2-3 weeks with the use of levothyroxine, but it takes around 6 weeks to bring TSH levels to normal. TSH monitoring is done every six weekly with the change of levothyroxine dose. Once TSH comes within range, thyroid profile test is conducted once yearly. The use of hormone replacement therapy and oral contraceptives raises the total T4 levels, so free T4 is also measured if the patient is taking any of these medicines. The usual dose of levothyroxine is 100-200 micrograms daily.

Hypothyroidism

Primary hypothyroidism is due to autoimmune disease (Hashimoto’s disease) in which the body produces antibodies against the thyroid gland. Possible causes are:

• Congenital- poor production of thyroid gland.
• Enzymes defect in thyroid gland.
• Dietary iodine deficieny
• Surgical removal of thyroid gland.
• Over treatment with antithyroid medicine.
• Radioactive iodine therapy.
• Lithium and amiodarone.

Secondary hypothyroidism results from an underproduction of thyroid hormones characterized by deficient thyroid stimulating hormone (TSH) stimulation by pituitary gland.

Case Study on weight gain

Hypothyroidism- low metabolic rate leading to weight gain, even on a calorie controlled diet, hair thinning and feeling cold.

Case Study- Pyridostigmine Use in Myasthenia Gravis

Pyridostimine is less powerful and slower in action than neostigmine but it has longer duration of action. It has mild gastrointestinal side effects, but antimuscarinic drug is still required for stomach cramps. The total daily dose of 450 mg should not be exceeded as it leads to acetylcholine receptor downregulation. Immunosuppressant therapy is required at a daily dose of 360 mg. it is only available as a tablet, unlike neostigmine which is available as a tablet and an injection.

case study- Myasthenia Gravis

 

• The presence of acetylcholine receptor antibodies.
• Edrophonium test: in which edrophonium chloride is injected intravenously to prevent acetylcholine degradation, hence the level of acetylcholine increases at the neuromuscular junction.
• Nerve conduction study: conducted for fatigue, in which repetitive neuronal stimulation is done. It results in decrements of muscle action potential due to impaired nerve to muscle conduction.

Case Study: Muscle Weakness

ANS: MYASTHENIA GRAVIS

It is an autoimmune disease which is characterized by muscle weakness that starts with exercise and resolves at rest.Ptosis (drooping of eyelids) is common characterized by blurred vision due to affected eye muscles that control the eye movements. Antibodies target the acetylcholine receptors by altering or destroying them at the neuromuscular junction, hence contraction of the muscles does not take place, and there are fewer acetylcholine receptors available so the muscles receive fewer nerve signals.

acetylcholine