4 6 75% NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE Part II-Additional Te

Question

4 6 75% NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE Part II-Additional Testing Dr. O'Ddll continued. "Low TSH levels should result in low thynoxin levels, not the reverse. Something seems to be stimulating the thyroid in the absence of TSH. When I saw your resules, I spoke to Dr. Rasam and he sugrested sp ecial ELISA test on the blood sample I collected fnom you. The ELISA result indicates that Carrie shows early signs of Graves disease. Both Carrie and Robert looked confased. Carric, a subset of your immune system antibodies is mistakenly attacking your thyroid gland, causing an increase in hormone production. Common symptoms include insomnia, anxiety, fatigue, heat sensitivity, weight loss, and increased sweating. Your hair might get brittle, and ypur menstrual cycle might change. Carrie nodded. "Tve had all those symptoms But this Graves disease can be cured. right asked Robert, holding Carrie's hand tightly le's treatable, yes, but this autoimmunity is a lifelong problem that has to be carcfully managed to avoid sympeoms such as eye swelling or bulging often seen in Graves patients, as well as other complications Questions 1. Consider the immunological involvement in this case, and the time frame over which it has occurred 2. Return to your thyroid-piruitary diagram. Explain the consequences to both thyroxin and TSH levels: 3 Does cither scenario in Question 2 above fit Carrics hormone data a. Which antibody (dp) class was prodaced first in this sequence of events b. Which class is most likely involved in an ongoing autoimmunity situation a. if the auto-antibodies are against the thyroxin molecule b. if the auto-antibodies are against the TSH molecule 4. Anti-receptor antibodies can block hormone entry or stimulate the receptor (like original hormone). Use your diagram to explain the consequences to both thyroxin and TSH levels if the auto-antibodies a. block the thyroxin rccopeots on the pituitary b. stimulate the thysoxin rceptors on the pituitary c. block the TSH receptors on the thyroid d. stimulate the 1SH receptos on the thyroid. 5. Does any scenario in Question 4 fit Carrics hormone datal What must be the problem in Graves disease? 6. Identify the type of hypersensitivicy (by name and number) thar Carrie is experiencing.

Explanation / Answer

1) a) The antibody class that is most likely produced first in the development of Grave's disease is IgM.

b) The present antibody class in the patient would be IgG

2) a) If the auto antibodies are against the thyroxine molecule, there will be a decrease in thyroid hormone levels. The levels of TSH will increase.

b) If the auto antibodies are against the TSH molecule, there will be decrease in both TSH and thyroid hormone levels.

3) Either scenarios does not account for the symptoms that Carrie is having at present.

4) If thyroxin receptors in pituitary are blocked, TSH secretion is increased.

b) If throwing receptors in pituitary are stimulated, TSH secretion is decreased.

c) If TSH receptors in thyroid is blocked, thyroid hormone levels will decrease.

d) If TSH receptors in thyroid is stimulated, thyroid hormone levels will increase.

5) Carrie is experiencing symptoms that are related to increase in thyroid hormone levels. This corresponds to condition in the question 4d.

6) Graves disease is a kind of type II hypersensitivity reaction.

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