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CASE ANALYSIS

PRIMARY HYPERTHYROIDISM
GROUP 6:
A Q U I N O, T R I S TA N J OY
B O L IVA R , K R I S T IN E J OY
C A N L A PA N , K AT R I N A
TAYA G , J O H N M A R L O

INTRODUCTION
Thyroid gland Thyroxine (T4) and
Triiodothyronine (T3)
control bodymetabolism
Hyperthyroidism - excess of circulating thyroid
hormone
Thyrotoxicosis - group of syndromes; high levels
of free thyroid hormone in the circulation
Graves disease - most common cause of
thyrotoxicosis or hyperthyroidism, especially in
children

CASE SUMMARY
11-year-old girl
weight loss, heat intolerance and
experienced a decline in grades at school
no significant past medical history but both
of her grandmothers had a thyroid disease
Thyroid function tests results: increased free
thyroxine (T4), increased total
triiodothyronine (T3) and decreased thyroidstimulating hormone (TSH).

CASE SUMMARY

ANSWERS TO GUIDE QUESTIONS


1. Explain briefly the pathophysiology of
primary hyperthyroidism.
.thyroid gland dysfunction - thyroid hormone
production is in excess
.autoimmune disorders - antibodies
(autoantibodies) activate TSH receptors
.bind to TSH receptors - produce excessive
amounts of thyroid hormone
.can also be caused by benign nodules and
leakage of thyroid hormone

ANSWERS TO GUIDE QUESTIONS


2. What are the abnormal results? Give the
indication of these results.

Free Thyroxine (T4) and Total triiodothyronine (T3) ELEVATED


TSH level - LOW
usually indicates an overactive thyroid gland that is
producing too much thyroid hormone

ANSWERS TO GUIDE QUESTIONS

2. What are the abnormal results?


Give the indication of these results.
Indications of increased T3 and T4 are:
Anxiety
Irritability or moodiness
Nervousness
Hyperactivity

ANSWERS TO GUIDE QUESTIONS

2. What are the abnormal results?


Give the indication of these results.
Indications of increased T3 and T4 are:
Sweating or sensitivity to high
temperatures
Hand trembling (shaking)
Hair loss
Missed or light menstrual periods

ANSWERS TO GUIDE QUESTIONS

3. Give the characteristic signs and


symptoms of the disease.

Signs
Tremor
Warm, moist, flushed, smooth skin
Ophthalmopathy (Graves disease)
Goiter
Brisk deep tendon reflexes

ANSWERS TO GUIDE QUESTIONS


3. Give the characteristic signs and
symptoms of the disease.

Signs
Muscle wasting and weakness
Dermopathy/pretibial myxedema (Graves
disease)
Tachycardia
Lid lag, widened palpebral fissures
Goiter
Osteopenia, osteoporosis

ANSWERS TO GUIDE QUESTIONS

3. Give the characteristic signs and


symptoms of the disease.

Symptoms
Nervousness, irritability, anxiety
Tremor
Palpitations
Fatigue, weakness, decreased
exercise tolerance

ANSWERS TO GUIDE QUESTIONS

3. Give the characteristic signs and


symptoms of the disease.

Symptoms
Weight loss
Heat intolerance
Prominence of eyes
Hyperdefecation
Menstrual changes (oligomenorrhea)

ANSWERS TO GUIDE QUESTIONS


4. Explain why TSH levels are low in cases of
primary hyperthyroidism.
body compensates for the very high levels of
thyroid hormone produced by the thyroid gland
negative feedback mechanism - reduce the
production of the thyroid hormone = reducing the
amount of TSH
High TSH levels = higher levels of thyroid hormone
if this persists, dysfunction in the pituitary gland
(secondary hyperthyroidism)

ANSWERS TO GUIDE QUESTIONS

5. Give the difference between


primary, secondary, tertiary, and
subclinical hyperthyroidism based on
the following lab test: T3, T4, and
TSH

ANSWERS TO GUIDE QUESTIONS


6. Explain the significance of testing the titer
of Anti-TSH receptor in primary
hyperthyroidism.
help diagnose Graves disease
autoimmune disorder - body produces antibodies
(autoantibodies) that activate the TSH receptor
help diagnose anautoimmune thyroid disease and
distinguish it from other forms of thyroid
dysfunction (block or stimulate)
TSH receptor antibodies, Thyroid-stimulating
immunoglobulins (TSI)

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