PROFESSOR INSTRUCTIONS: Michael is a thirty-year-old salesman who spends approximately 4 days each week traveling to visit customers in his region. During his routine physical, he casually mentions to his physician that he seems to be sweating more profusely than normal and most rooms that once were comfortable are now too “hot.” He thought that it was simply due to the change in seasons and companies being slow to turn down the thermostats from the winter temperatures. However, this problem seems to persist even when he is at home. A room that his wife and children find to be comfortable causes him to sweat profusely. Michael also reports that he seems to be losing weight even though his appetite has increased. He also complains that he has a shortened attention span and always wants to move around. Although he feels fatigued, Michael claims to have difficulty sleeping and seems to have more frequent bowel movements, occasionally accompanied by diarrhea. The physician checks Michael’s medical history and finds that he has lost 15 pounds since his last physical. Wanting to rule out the possibility of infection with the human immunodeficiency virus (HIV), the physician asks Michael questions about his sexual history and practices and finds that he is not at risk for HIV infection. Also, in checking his chart, the physician finds that Michael has a negative history of chronic illnesses, does not smoke, and has a low risk for cardiovascular disease. He does, however, have a positive family history of autoimmune diseases. His father suffers from idiopathic thrombocytopenia; his mother has been diagnosed with rheumatoid arthritis, and his oldest sister was recently diagnosed with systemic lupus erythematosus.
Michael’s physical examination results were within normal ranges except the following: he demonstrated tachycardia, loud heart sounds, and apparent cardiac arrhythmia accompanied by slight hypertension. The electrocardiogram confirmed the arrhythmia to be supra-ventricular in origin. Michael’s eyeballs appeared large and protruding, and his hair was fine and soft. He was also beginning to demonstrate some degree of alopecia. Michael was also observed to have palmar erythema. Palpation of the neck revealed the presence of a goiter. Blood test results indicated elevated concentrations of thyroid hormones (thyroxin and triiodothyronine), hypercalcemia, and decreased circulating lipids concentrations. Based on the physical characteristics and blood test results, Michael’s physician suspected that Michael was suffering from some form of hyperthyroidism and sent him to an endocrinologist to confirm the initial diagnosis.
Following the initial consultation and examination, the endocrinologist ordered tests to determine whether Michael was indeed hyperthyroid. The test results indicated an elevation in the concentration of thyroid hormones in the blood and the presence of thyroid-stimulating antibodies. These antibodies stimulate the thyroid gland by binding with the thyroid-stimulating hormone receptor located on the plasma membrane of the thyroid gland’s follicular cells. Based on these results, the endocrinologist concluded that Michael had Grave’s disease, a form of hyperthyroidism believed to be autoimmune in nature. Michael was presented with several possible treatment options. These included treatment with chemicals (propylthiouracil and methimazole) that decrease the production of thyroid hormones by the thyroid gland, radio-isotopic destruction of the thyroid gland by the use of 131I surgical removal of the thyroid gland. After considering all the options, especially the possible effects of radiation on gamete development, Michael chose surgery. Following successful surgery, Michael was prescribed synthetic thyroid hormone to ensure that his body was receiving adequate thyroid hormone and told to return within 2 months for a follow-up evaluation of circulating thyroid hormone concentrations. He was also cautioned to monitor his calcium intake carefully.
Using the terms covered this week, answer the following questions about this case:
What does the thyroid gland do and why would an imbalance in thyroid hormones have such a widespread effect on the body?
Why was goiter observed in Michael’s case?
Given that Michael and his wife may want to have more children, why was radio-isotopic to destroy the thyroid gland ruled out?
Here is a brief summary of the discussion board requirements. Please review the rubric for more specific information.
The initial discussion post must be at least 250 words of content, referencing the week’s reading and including a scholarly source.
Students will respond to two classmates weekly on the discussion board and give at least 50 words of substantive feedback.
I encourage students to respond to me but remember responding to me does not count as responding to two classmates.
All posts need a reference and intext citations. Your initial post should never be all opinion. You need to refer to the reading and required resources.
Discussion posts are due on Wednesday at 11:59 PM EST. Late discussion posts will not be accepted even with documentation because this is an attendance/participation grade for the week.
Plagiarism of any kind can result in a “0”.
You must post your initial post before you see other students’ responses. Adding a “.” or other short words/sentence, or entering and leaving without a post submitted, to review what others provided before you give your initial post will be deleted, and the grade for the week’s board will be a 0.
All references and other pertinent material must be included with the original post. Any information that is added after the initial post is submitted will not count for the grade.
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