Lucy sat in a small exam room of the student health center, feverish and with a
ID: 186749 • Letter: L
Question
Lucy sat in a small exam room of the student health center, feverish and with a throbbing headache. A sinus infection right before midterms was not what she needed.
Dr. House entered in a rush and took a quick look at her chart. “Hmm … fever, headache, green nasal discharge that you’ve had for two weeks. Sounds like your sinuses have been invaded by something nasty. Does this hurt?” He pressed his thumbs on Lucy’s cheeks, which nearly sent her through the ceiling. “Yep. Let’s try some antibiotics to clear that up.”
He reached for his prescription pad, but stopped and glanced at Lucy’s face again. “Your eyes protrude a bit. Have they always been that way?” He turned her face to look at her profile and frowned slightly.
Lucy had no idea what her eyes had to do with her sinus infection. “I haven’t noticed. But I’ve been so stressed lately that I don’t notice a lot of things.” She paused and then continued, “My little brother did start calling me ‘Bug Eyes’ this summer, but he’s just an annoying 10-year-old.”
Dr. House nodded and then gently palpated her neck. He looked at her chart again. “Your blood pressure and pulse are elevated. Your fever might account for that, but there could be something else going on here.” Lucy felt a small knot form in her stomach. This was supposed to be a simple sinus infection, nothing more.
Dr. House began to fire questions at her. Did she have trouble sleeping? Did she often feel nervous or “jittery”? Had she lost weight recently? Did she often feel like the room was too warm? Did she have frequent bowel movements or diarrhea?
Lucy’s head spun. “Uh, y-yeah, but I’m just stressed, you know, with classes. Aren’t all those things just signs of stress?”
“They certainly can result from stress, and I see a lot of students where that is the case. However, there is a slight swelling in the front of your neck. That combined with your other symptoms suggests that perhaps your thyroid gland isn’t functioning quite the way it should. I’d like to take a look before we assume your symptoms are all due to stress. Let’s start with some simple blood tests and see what we find.”
He scribbled a lab order and smiled kindly. Lucy grabbed the papers and left, feeling worse than when she first came in.
Questions
1.Where is the thyroid gland located?
2.List the hormones secreted by the thyroid and describe their general actions.
3.What is the significance of the slight swelling in Lucy’s neck?
4.Based on the information you have at this point, do you think Lucy’s thyroid gland is hyperactive or hypoactive? Explain your answer.
5. Dr. House ordered blood tests to measure Lucy’s levels of thyroid hormone and thyroid-stimulating hormone (TSH or thyrotropin).
1.If Lucy has a hyperactive thyroid, what are the expected results?
Blood TH levels elevated/decreased/normal levels (circle one)
Blood TSH levels elevated/decreased/normal levels (circle one)
2.What are the anticipated results if she has a hypoactive thyroid?
Blood TH levels elevated/decreased/normal levels (circle one)
Blood TSH levels elevated/decreased/normal levels (circle one)
Explanation / Answer
Q1: thyroid gland is located in the neck region around adam's apple (sound box).
Q2: Thyroid gland secretes two hormones i-e: thyroxine and calcitonin. Thyroxine maintains basal metabolic rate at optimum.It enhances matabolism of carbohydraytes, fats and proteins.It maintains libido.It is important for long lasting memory.it maintains body heat.It also regulates digestive functions as well bone health.Calcitonin works antogonstic to parathormone secreted by parathyroid.It lowers the blood calcium levels and enhances deposition of calcium in bones.At the same time it increases blood phosphorus levels.
Q3: It is a symptom of hypothyroidism i-e thyroxine production is low.
Q4: Based on given information it is clear that Lucy's thyroid gland is hypoactive.The symptoms like swollen neck, bulged eyes suggest that the Lucy is suffereing from hypothyroidism.
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