The patient is suffering from hypothyroidism – this diagnosis is based on the fact that her TSH level is significantly higher than normal, while the free T4 level is seriously low (Patil et al., 2022). If it were subclinical hypothyroidism, the TSH level would only be slightly elevated, and her free T4 level would be in normal range (Patil et al., 2022). In case of hyperthyroidism – primary or subclinical – TSH would be low or normal and T4 would be high or low, respectively (Mathew et al., 2022). Thus, one can conclude that the patient has primary hypothyroidism, as only this disorder matches the patient’s levels of thyroid hormones.
Early stages of hypothyroidism are often characterized by the lack of visible symptoms; thus, it is common for the patient not to show any noticeable manifestations of the disorder (Patil et al., 2022). Moreover, acquired hypothyroidism is known to have certain features such as no specific symptoms and non-linear correlation between thyroid hormones levels and the severity of disorder’s manifestation (Patil et al., 2022). The patient is likely to develop common symptoms of hypothyroidism as her condition progresses, however it is hard to predict how strong they would be.
Chronic autoimmune thyroiditis is the most likely cause of the patient’s condition. The pituitary adenoma is much more likely to cause hyperthyroidism due to overproduction of thyroid stimulating hormone (Mathew et al., 2022). Autoimmune Graves’ disease is also associated with hyperthyroidism, as the immune system’s response facilitates increased production of thyroid hormones (Mathew et al., 2022). Meanwhile, Hashimoto’s thyroiditis is the most common reason behind the occurrence of acquired primary hypothyroidism in the United States, although on a global level, lack of iodine in the diet is considered the main cause (Patil et al., 2022). Overall, Hashimoto’s thyroiditis belongs to a large group of autoimmune diseases and is their typical representative (Patil et al., 2022). The nature of all autoimmune diseases in general lies in the fact that the immune system mistakenly begins to produce antibodies against the proteins of its own body. The reason is, on the one hand, the innate tendency of the immune system to such errors, and on the other hand, an encounter with a virus whose proteins are similar to those of thyroid cells. Hashimoto’s thyroiditis, in particular, is characterized by hereditary predispositions, and is much more common in women than in men (Patil et al., 2022).
Usually, with hypothyroidism, annual check-ups if TSH and T4 levels are in the reference range for this condition are enough (Patil et al., 2022). Thus, the patient can plan her evaluations to occur once a year to monitor the development of the disorder and adjust the treatment if necessary.
Weight gain, anxiety, fatigue, and cold intolerance are one of the most common symptoms of hypothyroidism (Patil et al., 2022). They are most possible to occur in patient’s case as her disorder progresses further. It is also important to know that, as pathological processes in the thyroid gland develop, the clinical picture begins to resemble chronic somatic or mental disorders, such as depression, for example. However, the levofloxacin therapy, which is usually prescribed in patients with hypothyroidism, should reduce or completely prevent these symptoms (Patil et al., 2022). Still, the patient should monitor her symptoms closely as her condition will develop over time.
References
Mathew, P., Gujral, J., & Rawla, P. (2022). Hyperthyroidism. StatPearls Publishing LLC.
Patil, N., Rehman, A., & Jialal, I. (2022). Hypothyroidism. StatPearls Publishing, Treasure Island.