Case Study Primary Hypothyroidism

1. What is the most likely etiological factor for Mrs. Baksh’s primary hypothyroidism? Explain in detail the pathophysiology of primary hypothyroidism using the complex feedback mechanism.
According to the American Thyroid Association, the three most common causes to hypothyroidism are: the surgical removal of the thyroid gland, radiation treatment and the body attacking thyroid tissue as a result of autoimmune diseases like Hashimoto’s thyroiditis (American Thyroid Association, 2014). In Mrs. Baksh’s case, the patient did not have any past medical history of thyroidal surgery or radiation treatment. Therefore the most likely etiological factor contributing to her primary hypothyroidism is autoimmune disease. In addition, due to the physical presence of a goiter (a visible enlarged, palpable, firm and non-nodular swelling of the thyroid gland), it further supports the conclusion
Thyroid hormones are key metabolic hormones that play a critical role in controlling the rate of metabolic reactions in the body (Adams et al., 2010). With low T3 and T4 levels, it causes a decrease in the metabolic rate, which causes a decrease in lipid metabolism in the body, leading to the accumulation of cholesterol. According to Pucci et al., TH stimulates increase mobilization of triglycerides to be stored in adipose tissue and stimulates the elimination of low-density lipoproteins (LDL) (Pucci et al., 2000). Within a hypothyroid patient, low levels of TH causes triglycerides to accumulate in the blood and causes LDL to be absorbed by the liver, reducing its excretion, putting the patient at risk of developing hypercholesterolemia and hyperlipidemia (Pucci et al., 2000). A high level of LDL and cholesterol predisposes the patient of health risks such as atherosclerosis, myocardial infarction and/or stroke. In addition, the patient has type 2 diabetes, which is associated with high blood lipids