Case Study 1: Diabetes and Thyroid
- Jill, a 45-year-old Caucasian female, is 5′4″ and weighs 195 lb. She takes lisinopril 20mg daily. The NP documents acanthosis nigricans on her posterior neck.
2H OGTT: FBS 120, 2H 198
Lipids: TC 240, trigs 200, HDL 35, LDL 160, VLDL 45
Fasting insulin level: 30 (will use reference range 10-20 mcU/ml per Health Central website)
C- peptide: 10 (reference range of C-peptide is 0.8-3.1 ng/mL per Medscape)
- From a pathophysiological perspective, analyze, interpret, and explain the interrelationship of the concepts of visceral fat, obesity, insulin resistance, metabolic syndrome, prediabetes, and T2DM (type 2 diabetes mellitus) as they apply to Jill’s data. Dedicate one paragraph to each of the concepts. Make sure you incorporate every single piece of data into your discussion and personalize your discussion to Jill’s scenario.
- Crystal, a 25-year-old female, presents to the clinic with a complaint of a 10-lb. weight gain over the past few months despite intensive exercise and diet regimen. She expresses feeling more constipated, tired, and having to force herself to get through the day even though she sleeps 8–9 hours/night. Her menses are heavier and her skin is noticeably drier. She is actively trying to conceive. Her mother and sister have hypothyroidism.
TPO antibodies: Normal
Thyroglobulin antibodies: Normal
- What is Crystal’s diagnosis and explain how you arrived at it?
- Discuss two different opinions (from two different sources) that support treating versus not treating Crystal’s diagnosis. Each opinion must be supported by research and can be EBP guidelines. One paragraph for each opinion will suffice. Lastly, which opinion would you support in managing Crystal? Why?
- Crystal presents to the clinic three months later and has gained 5 more pounds. She expresses feeling more fatigue, sluggish cognition, cold all the time, constipated, swelling in her hands and ankles, and has noticed some hair thinning and coarseness. She informs you that she thinks she probably needs thyroid medicine like her mother and sister but she really doesn’t want to take it. She decided after the last visit that she preferred to “not take medicine” and wants to just “treat everything natural.” She also isn’t trying to conceive anymore and is using natural family planning.
TSH: 22 (0.45-4.50)
FT4: 0.4 (0.7-2)
T3: 58 (60-180)
TPO antibodies – Positive
Thyroglobulin antibodies – Positive
Lipids: LDL 190, Trigs 275, HDL 32
- What is Crystal’s diagnosis now? Support your answer by interpreting her labs. Make sure you explain WHY her TSH, FT4, T3, TPO antibodies, thyroglobulin antibodies are abnormal.
- Why would her lipids be abnormal?
- How is this different from Crystal’s previous diagnosis? Explain from a pathophysiological perspective where the negative feedback loop was broken in Crystal’s case resulting in this diagnosis.
- What does she need for treatment? Why?
- How would you respond to her statement that she prefers to “not take medicine” and just wants to “treat everything natural?”
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