Evaluation and Management of Elevated TSH in a 42-Year-Old Woman- Differential Diagnosis and Evidence-Based Treatment Options

Evaluation and Management of Elevated TSH in a 42-Year-Old Woman- Differential Diagnosis and Evidence-Based Treatment Options

Elevated thyroid stimulating hormone (TSH) levels in blood are indicative of an underactive thyroid gland, whereby it does not produce enough thyroid hormone (Faust & Krone, 2014). In response, the pituitary gland produces excessive amounts of TSH in an attempt to stimulate the thyroid gland (Schubel et al., 2017). The human body’s chemical reactions balance is upset whenever the thyroid gland does not work correctly because the gland is vital in the endocrine system, influencing many chemical reactions. The three most probable diagnoses for the above patient are hypothyroidism, menopause, and Hashimoto’s disease.

Hypothyroidism

Hypothyroidism is a thyroid condition in which the thyroid gland underperforms hormone production (Duntas & Yen, 2019). Though it can occur across ages, the risk increases with increasing age, especially in women. The case study patient is a woman, forty-two years old. The signs and symptoms of the disease include fatigue, elevated TSH level, weight gain, and dry skin, which are elicited in the case of the patient. A diagnosis of hypothyroidism is highly likely because other biochemistry tests were normal. Treatment with oral Levothyroxine, a synthetic thyroid hormone, has proven effective and safe (Mayo Clinic, 2020). The dosage is dependent on and requires regular monitoring of TSH levels.

Menopause

The ceasing of menstrual cycles marks menopause. The natural decline of reproductive hormones is the leading cause in women over 40. Symptoms include hot flashes, weight gain, dry skin, and sleep problems (NHS, 2021). The fatigue could result from sleep disturbances with her advanced age, while the weight gain is due to decreased metabolism. The menopausal transition could be the cause of the elevated TSH level. Treatment may involve getting enough sleep, eating a balanced diet, regular exercises to keep skin supple, monitoring TSH levels, and further evaluations to determine any underlying conditions that could raise TSH levels.

Hashimoto’s Disease

Hashimoto’s disease is an autoimmune condition causing thyroid inflammation (American Thyroid Association, n.d). The disorder causes gradual cell damage and function decline and impairs thyroid hormone production. Symptoms include sensitivity to cold, weight gain, dry skin, fatigue, elevated TSH levels, and reduced tolerance to exercise. Treatment involves lifelong oral levothyroxine therapy. TSH monitoring is required to determine the correct dosage.

References

American Thyroid Association. (n.d). Hashimoto’s Thyroiditis. https://www.thyroid.org/hashimotos-thyroiditis/

Duntas, L. & Yen, P. (2019). Diagnosis and treatment of hypothyroidism in the elderly. Endocrine, 66(1), 63–69. https://doi.org/10.1007/s12020-019-02067-9

Faust, M. & Krone, W. (2014). Incidental finding: elevated TSH level. Der Internist, 55(10), 1149–1156.  https://doi.org/10.1007/s00108-014-3589-4

Mayo Clinic. (2020). Hypothyroidism (underactive thyroid) – Diagnosis and Treatment  https://www.mayoclinic.org/diseases-conditions/hypothyroidism/diagnosis-treatment/drc-20350289

NHS. (2021). Menopause. https://www.nhs.uk/conditions/menopause/

Schübel, J., Feldkamp, J., Bergmann, A., Drossard, W. & Voigt, K. (2017). Latent Hypothyroidism in Adults. Deutsches Arzteblatt international, 114(25), 430–438.  https://doi.org/10.3238/

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A 42-year-old woman has noticed dry skin, fatigue, and weight gain over the past 3 months. Her blood pressure is 110/70 mm Hg, pulse 60/min, and heart and lungs are normal. Her skin feels rough and dry, but the rest of her examination is normal. Her biochemistry is normal, but the TSH is 39 mU/L. Provide at least 3 possible differential diagnoses and justify your rationale.

Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

Expectations

Length: A minimum of 350 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last 5 years