A Case Study on the Endocrine System 4

Part IV – Options


Dr. Simmons continued. “I’m going to refer you to a local
endocrinologist, someone who specializes in disorders like this. She
will probably order a radioactive iodine uptake test and a thyroid scan
to confirm that you have Graves’ disease and determine the best way to
treat it.”

At Ellie’s look of alarm, he explained. “Don’t worry … the amount of
radioactivity is very small and not harmful, so you won’t start to glow.
The thyroid gland incorporates iodine into its hormones, and if we tag
the iodine with radioactivity, we can measure the amount of iodine taken
up by the thyroid.”

Ellie jumped in. “And if my thyroid is overactive, it will use more
iodine than it should, right?”

“Exactly,” responded the doctor. “Assuming that your uptake is
elevated, there are several ways to treat your condition. Unfortunately,
we can’t cure it. However, there are some medications that can help,
and another procedure that involves radioactive iodine. Surgery to
remove the thyroid is also an option, although not a common one anymore.
The endocrinologist will evaluate your test results and help you choose
the best treatment. Until then, I’m going to prescribe a beta-blocker
that should help lower your heart rate and reduce that nervous feeling
you’ve had.”

Several weeks later, Ellie dropped her backpack beside the chair in
Dr. Kern’s office and sat down with her latest physiology exam and a
smile. “I think there’s hope!”

“I agree. Tell me about this dramatic turn-around,” Dr. Kern smiled
in return. Ellie was still very thin and her blue eyes startlingly wide.
However, the fidgeting and shakiness were gone and the overall
impression was one of calmness and purpose.

Ellie explained how a sinus infection led to discovery of her thyroid
disorder. “I’m taking some medication now until the radioactive iodine
treatment becomes effective, and I feel so much better. I can sleep, I
can concentrate, and I think I can pull up my grade enough to pass the
course!”

Dr. Kern smiled again. “So often signs of stress are just that, but
occasionally there is another explanation. I’m so glad you found out
what was going on sooner rather than later, and I’m sure this will
reduce your stress levels even further. We’ll look for even better
results on the next exam.”

Ellie laughed. “Oh, it covers the thyroid gland. I think I can ace
that part!”

Questions

1. Ellie is a 20-year-old female. Do some research on the average
   age of onset and any gender differences in Graves’ disease to see if
   Ellie’s diagnosis is unusual.
   
2. How are beta-blockers like propranolol helpful as an initial
   treatment for Graves’ disease? Do they have any effect in reducing
   thyroid hormone levels or do they counter the effects of the hormones?
   
3. After Ellie’s diagnosis of Graves’ disease was confirmed by the
   uptake test, her endocrinologist explained several options for long-term
   treatment, which are listed below. For each treatment, describe the
   major advantages and disadvantages.
   
   
   1. Anti-thyroid medications (methimazole, propylthiouracil)—these
      medications slow the production of thyroid hormones.
      
   2. Radioactive iodine—a stronger dose of radioactive iodine is given
      to gradually destroy the thyroid gland.
      
   3. Surgery—part or all of the thyroid gland is removed.
      
   
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