A CASE ON HYPOTHYROIDSM
INTRODUCTION
Hypothyroidism is when the thyroid gland does not produce enough thyroid hormones to meet
the needs of the body. The thyroid gland is found in the front of the neck below the larynx.
Or voice box, and has two lobes. one on each side of the windpipe. It is an endocrine gland,
made up of special cells that make hormones. Thyroid hormones regulate metabolism, or the
way the body uses energy. If thyroxine levels are low, many of the body's functions slow down.
The production of thyroid hormones is regulated by thyroid stimulating hormone (TSH)
which is made by the pituitary gland.
CAUSES
Hypothyroidism can occur if the thyroid gland fails to work properly, or if the thyroid gland is
not stimulated properly by the hypothalamus or pituitary gland.
SYMPTOMS
Thyroid hormones affect multiple organ systems. So the symptoms of hypothyroidism are wide
ranging and diverse. Symptom: of hypothyroidism commonly include, but are not limited to:
Fatigue
Weight Gain
Slowed Heat Rate. Movements, And Speech
Joint And Muscle Pain, Cramps, And Weakness
Constipation
Dry Skin
Thin, Brittle Hair or Fingernails
Heavy Periods, Or Menorrhagia
CASE SCENARIO
DEMOGRAPHIC DETAILS
Patient name : Mrs. DGF
Age : 65 years
Gender : Female
Date of admission : 08-01-2021
Date of discharge : 13-01-2021
Food Habits : Non- Vegeterian
Family History : Nil
Past Medical History : K/C/O Diabetes mellitus x 20 years and Hypertension x 3years
Chief Complaints : Fever and Disorientation x 3 days
Diagnosis : Urosepsis, Diabetic Nephropathy, and Hypothyroidism.
ANTHROPOMETRIC DETAILS
Height (cm) : 153
Current Weight (kg) : 58.6
Usual body weight (kg) : 62
Ideal Body weight (kg) : 49
Body Mass index (kg/m2) : 24.08
Weight loss (%) : 5.48
BIOCHEMICAL PARAMETERS
Parameters Patient’s value Reference value
(On admission)
Hemoglobin (mg/dL) 9.9 13- 18
WBC (103/mm3) 17.02 4- 11
PCV (%) 25 40- 54
Platelets (103/mm3) 363 150- 450
S. Albumin (gm/dL) 3.8 3.5- 5.2
Total protein (gm/dL) 6.9 6.4- 8.2
RBS (mg/dL) 211 4- 6
HbA1c (%) 11 4- 6
TSH (mU/mL) 5.5 0.4- 4
NUTRITIONAL ASSESSMENT:
Routine screening was carried out by the doctor followed by which detailed Nutritional
Assessment was done by the Clinical Dietitian using Subjective Global Assessment (SGA). SGA
showed the following details:
SUBJECTIVE GLOBAL ASSESSMENT:
Weight change Weight loss 5-10% (3)
Dietary intake Sub-optimal solid diet (2)
GI symptoms Vomiting or Moderate GI symptoms (3)
Functional Capacity Light activity (1)
Co-Morbidity Moderate Co-Morbidity (4)
Decreased Fat score Mild (2)
Muscle Wasting Mild (2)
SGA SCORE 19
Interpretation Moderately Malnourished
PESS Statement: This 65 year old female patient was assessed to be Moderately Malnourished
as related to inadequate oral intake due to GI discomfort as evidenced by Subjective Global
Assessment.
24- hr DIETARY RECALL (HOME RECALL)
Energy : 1580 Calories
Protein : 59 g
FOOD AND DRUG INTERACTION: Nil
MEDICAL NUTRITIONAL THERAPY
To provide adequate calories and protein
To maximize quality of life
To reduce length of stay.
NUTRITIONAL REQUIREMENT
Energy :1700 kcals @35 kcals/kg IBW
Protein : 70 g @ 1.5 g/kg IBW
Nutrition Care Plan: 1700 calories, 70 g proteins, 6 g salt restricted, diabetic soft diet.
Days Feeding route Prescribed Provided Remarks
Energy Protein (g) Energy Protein
(Kcal) (Kcal) (g)
1 Soft solid diet 680 18 -
2 Soft solid diet 870 24 -
3 Soft solid diet 1000 30 -
ONS 134 6 -
Total 1134 36 -
4 Abdominal
Diabetic diet 730 20 discomfort
ONS 1700 70 268 11 -
Total 998 31 -
5 Diabetic diet 1270 39 -
ONS 268 11 -
Total 1538 50 -
6 Diabetic diet 1370 48 -
ONS 268 11 -
Total 1638 59 -
NUTRITIONAL REQUIREMENTS MET DURING THE HOSPITAL STAY
120
100
96
90
% of Nutrients Achieved
80 84
71
60 67
59
51 51
40 44
40
34
20 26
0
1 2 3 4 5 6
No. of Days
Energy Protein
CASE PROGRESSION
On the day of admission, patient was nutritionally assessed to be malnourished 1700
calories, 70 g protein, 6 g salt restricted, diabetic soft solid diet was prescribed on day 1. On day
3, to meet the nutritional demands High calorie, High protein Oral Nutritional Supplement
(ONS) was suggested. On day 4, patient had abdominal discomfort and had a poor oral intake.
Diet consistency was progressed from soft solid to normal diet. Patient’s oral intake was
gradually improving, and the patient tolerated ONS well. On the day of discharge, energy and
protein requirements met were 96% and 84% respectively.
DISCHARGE ADVICE
1700 calories, 70g protein, Low salt, Diabetic diet was prescribed as discharge diet as per
doctor’s order. Emphasised on importance of Oral Nutritional Supplement (ONS) and educated
the patient to take ONS for better outcome. Motivated the patient to eat well. Diet chart given on
discharge.
