A Case Study on the Endocrine System 2

Part II – Health Center


Ellie 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. Simmons 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 Ellie’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
Ellie’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.

Ellie 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. Simmons 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.” Ellie felt a small knot form in her stomach. This was supposed to
be a simple sinus infection, nothing more.

Dr. Simmons 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?

Ellie’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. Ellie 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. Protrusion of the eyes is called exophthalmos. How is it related
   to thyroid dysfunction? What causes it?
   
4. What is the significance of the slight swelling in Ellie’s neck?
   
5. Based on the information you have at this point, do you think
   Ellie’s thyroid gland is hyperactive or hypoactive? Explain your answer.
   
6. Dr. Simmons ordered blood tests to measure Ellie’s levels of
   thyroid hormone and thyroid-stimulating hormone (TSH or thyrotropin). If
   Ellie has a hyperactive thyroid, what are the expected results? What
   are the anticipated results if she has a hypoactive thyroid?