A 26-year-old woman is in the clinic today for evaluation of weight gain and fatigue. She is 5 feet 6 inches and weighs 175 pounds. Prior to her pregnancy, she weighed 130 pounds and her maximum weight during pregnancy was 155 pounds. She is now 18 months postpartum and continuing to gain weight despite no change in diet or activity. She reports that the fatigue is getting worse even though her daughter is sleeping reliably through the night and the patient feels she is getting plenty of rest. She takes no other medications and has no significant medical history. Her vital signs today are HR 68, BP 108/60, RR 10, temperature 97° F. The nurse practitioner orders a CBC, TSH, and T4.1. What sources of fatigue is the nurse practitioner evaluating with the CBC, T4, and TSH?2. What other history or clinical findings would be indicative of hypothyroidism?3. The patient’s laboratory values show an elevated TSH and a low T4. What does this mean?4. After starting the patient on thyroid hormone replacement, the nurse practitioner asks the patient to return in 8 weeks to check her TSH level. What is the purpose of this test? What should be done if the test result is abnormal?

Studies based on tsh concentrations would indicate whether the thyroid hormones, which are t4 and t3, are in decline or in deficit.

This deficit may be due to a pathology of the thyroid gland and that is why the tsh study is carried out. The TSH hormone is one that stimulates the thyroid gland through the glandular-nervous axis (CNS), if it is in deficit, you want to say that it is being poorly stimulated.

Other findings of hypothyroidism are overweight, decreased basal metabolism, alterations in the cardiovascular system, and increased blood pressure.

That the TSH hormone is elevated, and there is a deficiency of t4, means that the hormone is suffering from some neoplasm, or some pathology that does not collaborate with the function of the gland, that is, that the axis between the central nervous system and The thyroid gland works perfectly, but what is defective is the gland, the body itself captures this deficit of t4 and stimulates the neuronal pathway even more, releasing more TSH, to overstimulate the thyroid gland and that it can generate the amount of t4 required.

The nurse seeks to know that if by administering t4 and balancing the values of this thyroid hormone, TSH normalizes and returns to its normal value, that is, it decreases and does not overstimulate the thyroid gland.

In the event that TSH does not decrease as expected, there will be a double problem to be solved, one at the nervous level and the other at the glandular level.

On the other hand, if the TSH level normalizes, we could understand that the TSH was increased because it wanted to "solve" the t4 deficit.

Explanation:

The thyroid gland works thanks to the stimulation exerted by the central nervous system through TSH.

The TSH hormone is the one that is responsible for stimulating the exact and fair secretion of t4 and t3, sometimes it tends to increase, due to negative feedback, since the increase in t4 and t3 causes the tsh to decrease and the right balance is reached . In case the hormones secreted by the thyroid are in deficit, this will be captured by the body and will not have this negative feedback, therefore the stimulation of the nervous axis will be increased.

The thyroid gland can suffer from metabolism syndromes where hypoactivity or hypothyroidism is detected, or hyperactivity which is also known as hyperthyroidism, although these syndromes are not the only ones, there are also other pathologies such as malignant and benign neoplasms, hashimoto's disease, among others.

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