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There are various cause of hypothyroidism which include lack of iodine and autoimmune condition Hashimoto’s thyroiditis, an injury in the hypothalamus, an initial treatment of a radioactive, pituitary gland, a previous thyroid surgery, and lack if a functioning thyroid at birth and even use of certain medications. When the TSH test shows it has come back to normal and the symptoms still show hypothyroid, the level of free T4 Should be measured in one’s blood stream. Most hypothyroid patient have high levels of TSH and low levels of T4 which is known as primary hypothyroidism. This takes place because the pituitary gland has realized that the thyroid does not produce enough hormones.

Due to that the pituitary gland releases more TSH in order to motivate the thyroid into a creating hormone (Allahabadia .et.al, 2009). If the thyroid is not functioning well it will not respond to the pituitary signs and this will lead to low levels of free T4 and high levels of TSH. When one has free T4 levels that are low the range will be lower than 5micrograms per deciliter.Bertha had pneumonia which is a lung disease and pleural effusion affect the lungs during inspiration and expiration. Bertha had pneumonia bacteria which comes together with parapneumonic effusion this might have led to pleural effusion (Light, 2007) .A pleural effusion occurs when an abnormal fluid collects in chest within the pleural and visceral areas. Bertha’s rate was reduced because er heart rate had slowed which lead to decreased blood circulation in the heart and other organs. Myxedema coma is an advanced hypothyroid and If Bertha does not get intensive care she is at high risk

References

Allahabadia A., Razvi S., Abraham P., Franklyn . Diagnosis and treatment of primary hypothyroidism. British Medical Journal (International Edition) [serial online]. 2009;338:1090. Available from: Health Module. Accessed February 19, 2010, Document ID: 1731734701.

Light RW. Pleural Diseases Fifth Edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.

Refetoff S. Thyroid function tests. In: DeGroot ED. ed. Endocrinology. New York: Grune & Stratton, 1979;1:387–428.

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