Assignment Task: Case Scenario Madeline (Maddy) Robinson is a 28-year-old woman who has been admitted to your clinic to investigate a lump in her neck and a cough that she has had for the past 3 weeks...

Assignment Task: Case Scenario Madeline (Maddy) Robinson is a 28-year-old woman who has been admitted to your clinic to investigate a lump in her neck and a cough that she has had for the past 3 weeks with no other cold symptoms. She has also been feeling weak, has had trouble sleeping and feels “hot” in bed. She has also lost weight and her menstrual cycle has been odd (scant flow and an increase in time between periods). Upon examination the lump is in Maddy’s thyroid and the doctor takes a fine needle biopsy and orders thyroid blood tests as well. The blood tests come back and Maddy’s TSH level is 0.02 mIU/L (normal range for TSH is 0.5-4.2 mIU/L), Free T4 38 pmol/L (normal range for free thyroxine is 10-20 pmol/L) and Free T3 14 pmol/L (normal range for free T3 is 3.5-6.0 pmol/L). The fine needle biopsy revealed that Maddy had Papillary Thyroid Cancer. 1.1 Describe the pathophysiology (cause, progression, outcome) of hyperthyroidism. Include in your answer risk factors for hyperthyroidism and the treatment options for hyperthyroidism. Demonstrate links to Maddy’s case (i.e. what would be appropriate in her case?) 1.2 Discuss the clinical manifestations of Maddy’s case and link to the pathophysiology. After discussion with her GP, Maddy is admitted to hospital for a total thyroidectomy. The operation is considered a success. While recovering in hospital (2 days post operation), Maddy has an appointment with the endocrinologist. She notes that she has been feeling lethargic, cold and her face feels “puffy”. She is also feeling depressed and is concerned about the scar from the operation. She has had a blood test before the appointment. The blood tests for Maddy are: TSH level is 4.5 mIU/L, Free T4 0.5 pmol/L and Free T3 0.3 pmol/L. 1.3 Differentiate between hyperthyroidism and hypothyroidism. Link this to Maddy’s case. 1.4 Discuss the blood results from both times Maddy had blood taken listed above. Explain the test and what the results indicate. Maddy is commenced on thyroxine (Eutroxsig Tablets) 100mcg daily and liothyronine sodium (tertroxin tablets) one a day. After one month on the medication she has a blood test. The endocrinologist is happy with the result, especially the TSH level. The blood tests for Maddy are: TSH level is 0.5 mIU/L, Free T4 15 pmol/L and Free T3 4 pmol/L. 1.5 Discuss medications Maddy is on (include use, action, side effects and nursing considerations). Apply relevant considerations to Maddy’s situation. 1.6 Discuss Maddy’s final blood test. Explain why the endocrinologist is interested in TSH levels in Maddy’s Limited Minimal Moderate High Comprehensive Lack of understanding of HYPERTHYROIDISM demonstrated. Few risk factors correctly identified.