CASE STUDY

VINCENT BILLY DOMINGO -AMACNA RMT

A 41-year-old woman presents to her primary care

physician with weight and hair loss, diarrhea,
nervousness, and eye pressure. She has no medical
problems, but some of her family members have
similar symptoms and require medication. On
examination, she is noted to have exophthalmos, an
enlarged goiter, hyperflexia, and tremor when her
arms are outstretched. The patient has a decreased
thyroid-stimulating hormone (TSH) level and an
increased free thyroxine (T4) level.

Guide Questions:

1. What is the best diagnosis of the patient? Please support your answer.
2. Explain coherently the pathogenesis of your diagnosis.
3. What is the mechanism by which high levels of iodine inhibit thyroid production?
4. Enumerate at least 4 ways to treat or manage the patient and explain each briefly.
5. Answer the following questions and provide rationalization per item:
I. A 33-year-old woman is noted by her physician to have some fatigue and some
coarse skin. Her only medication is an oral contraceptive agent. The following
laboratories have been returned:
a. Hyperthyroidism
b. Hypothyroidism
c. DNormal thyroid status
d. Transient hyperthyroidism
II. A 33-year-old chemist takes L-thyroxine (Synthroid) 1 ug orally each day. He asks
hoe the thyroxine works on cellular level. Which of the following is the best
explanation?
a. It binds onto membrane surface receptor and activates protein synthesis.
b. It binds onto membrane surface receptor and activates secondary messenger.
c. It binds onto a cytoplasmic receptor and the hormone-receptor complex diffuses
to the nucleus to affect transcription.
d. It has a direct effect on the hypothalamic nuclei affecting metabolism.
III. A 15-year-old adolescent is suspected of having anorexia nervosa. Thyroid function
tests are also drawn. Her TSH in the normal range, but the rT 3 level is elevated.
Which of the following is the most accurate statement regarding her status?
a. Reverse T3 has little biological effect.
b. This patient probably has T3 thyroditis.
c. The free rT3 would be the next step to access possible hyperthyroidism.
d. This patient probably has hypothyroidism.
Clinical Chemistry Didactics
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