Presentation: A 30-year-old male demonstrated a subtle onset of the following symptoms: dull facial expression; droopy eyelids; puffiness of the face and periorbital swelling; sparse, dry hair; dry, scaly skin; evidence of intellectual impairment; lethargy; a change of personality; bradycardia (60 b/min); a blood pressure of 90/70; anemia (hematocrit 27); enlarged heart (upon radiological exam); constipation, and hypothermia. Free radioimmunoassay (RIA) of peripheral blood indicated elevated TSH levels. A TSH stimulation test did not increase the output of thyroid hormones from the thyroid gland.
Questions: Choose one of the two sets of questions to serve as your initial response.
1. Which endocrine organ is involved here? Explain whether a TSH or TRH determination is necessary for your diagnosis?
2. Explain whether this is a primary or secondary disorder.
3. Describe the feedback loop involved, indicating if there is an increased or decreased TSH level.
OR
1. List several defects that could cause these symptoms.
2. Explain whether or not you would expect to find a palpable goiter.
3. Describe a suitable treatment for this individual.