ATIONAL CENTER FOR CASE STUDY TERGOHINGIN SCENCE Part IV-Treatment Options Carri

Question

ATIONAL CENTER FOR CASE STUDY TERGOHINGIN SCENCE Part IV-Treatment Options Carrie was silent for a moment as she touched her daughter's hair. "What about Hayden?" she asked. "Does our daughter have this too?" Dr. O'Dell pulled out another sheet of lab results. "Hayden's thyroxin levels were at the high end of mormal during her newborn blood screen. Did anyone suggest a follow-up blood test? No," answered Robert. "They said everything was fine." I'm afraid Hayden also has a problem, but one I hope is relatively casy to solve. Here's the daca Hayden (newbon) Hayden 3 mos 222 ug/dL 03 mIU/L Normal values 6-15 ugldl 03-3.04 mIUL Thyroid hormone (thyroxin) 15.0 u/dL Thyroid stimulating-hormone (TSHONot performed Questions I. Which values for Hayden (of those given) are abnormal or borderline 2. Given Carrie's diagnosis, what is the most likely sourcelcause of Hayden's problem 3. How did the "active agent" enter Hayden? Give two possible routes. 4. If Carrie had continued to breast feed, how would that have affected Hayden's peoblem 5. For Hayden, Dr. O'Dell suggests three months of a low dose anti-thyroid medication (such as methimazole) that will reduce her thyroxin production. Regular blood tests to monitor both thyroxin and TSH levels will be continued during this time. a. Why is short-term therapy (of several months duration) likely to work? b. Hayden's treatments would end about 6 months after her birth. Why is that number signiicane Will long-term therapy (years or lifetime) be needed? Why or why no d. Graves disease may have a heritable component. What future testing would you suggest for Hayden 6. a. Will this same therapy work for Carrie? What will happen as treatment progresses b. What about general immunosupression as a treatment? Name a potential consequence. 7. Dr. O'Dell explains that Carrie may need to have treatments with a shortr-lived radioactive isotope of iodine that will accumulate in her thyroid gland along with the normal iodine concentrating there a. What will these treatments accomplish? b. What will happen to antibody levels as a result? List the players and the general sequence of events Why would thyroid hormone pills be prescribed after treatment is completod d. Surgical removal of the thyroid gland (thyroidectomy) is rarely used to treat this problem. What would it accomplish here? Name a potential danger of this surgery (chink anatomically). 8. Could Carrie's problem be solved by a thyroid tranplant from a matching donor? Explain 9. Autoimmunities are relatively uncommon. What usually happens to autoimmune antibody-producing clones during development? Hot and Bothered" by Karin A. Grimne Page

Explanation / Answer

1) The levels of thyroxine in the blood of Hayden is elevated now and is in the borderline range during childbirth. Thyroid stimulating hormone (TSH) levels are in the borderline lower level at present.

2) Given Carrie's diagnosis, the most likely most likely cause of Hayden's problem is increased thyroxine secretion by thyroid glands because of thyroid stimulating antibodies. The diagnosis is Grave's disease.

3) Hayden got the disease because of genetic reasons, stress, and viral infection.

4) Breastfeeding is not involved in the development of Graves disease.

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