Hypothyroidism
An elderly woman (65 year old) had several weeks sensation of being cold, reduced appetite, but despite of that weight gain of 15 kg during last year. The examination showed pale, cool and puffy skin, bradycardia with decreased cardiac output, pleural effusion, hypoventilation, decreased deep tendon reflexes.
Questions and tasks:
1. Which diagnosis would you consider based on these data?
2. What can be reasons for this clinical condition?
3. What therapy would you recommend for this patient?
4. Which of the following is a sign or symptom that would be expected to occur in the event of chronic overdose with exogenous T4?
a. Bradycardia
b. Dry, puffy skin
c. Large tongue and drooping of eyelids
d. Lethargy, sleepiness
e. Weight loss
5. When initiating T4 therapy for an elderly patient with long-standing hypothyroidism, it is important to begin with small doses to avoid which of the following?
a. A flare-up of exophthalmos
b. Acute renal failure
c. Hemolysis
d. Overstimulation of the heart
e. Seizures
6. Describe the pharmacokinetic and pharmacodynamics differences between levothyroxin and liothyronine