Anatomy. Case Study. It's Just Stress

Questions
PART 1
1. Note anything unusual about Ellie's behavior or appearance.
As I noticed from the scenario, Ellie suffers from stress caused by school work and
exams from major subjects. In physical appearance, I noticed that she was trembling her
hands, very thin, and her eyes were protruding. She takes a brief or hurried look upon
reading the result knowing that she was notable to make it. She also emits a long, deep
expression of sadness, and tiredness for always trying her best but still getting a low
result. I also noticed that her behavior changes in a way that she can't sleep, and has a
hard time concentrating, memorizing, and understanding the lessons. She also
complains of her inability to retain information, and problems with her memory.
2. What do you think might be going on with Ellie that could cause her difficulties?
Consider both physical and psychological causes.
I strongly believe that the cause has something to do with hormones that affect her
behavior. From a Physical perspective, she was suffering from lack of sleep that may be
the cause of thyroid levels problems as supported in the scenario. She also showed lack
of dietary nutrition together with an over intake of caffeine, or drugs to make her awake
from studying, but sadly, no improvement happens with her study. Psychologically
speaking, she suffers from stress to focus on understanding, memorization and
concentration. Fear of failure makes her suffer from loss of confidence that makes her
more stressed.
PART 2
1. Where is the thyroid gland located?
The thyroid gland is located in front of the neck just below the Adam's apple (larynx). It is
butterfly-shaped and has two lobes located either side of the windpipe or trachea. A
normal thyroid gland is not usually outwardly visible or able to be felt if finger pressure is
applied to the neck.
2. List the hormones secreted by the thyroid and describe their general actions.
T3 Triiodothyronine, T4 Thyroxine, Calcitonin, and Parathyroid hormone
- T3 Triiodothyronine - is a 3 iodine that is very potent. It acts by modifying the genes

of transcription in virtually all tissues that alter the rates of protein synthesis and
substrate turnover
- T4 Thyroxine - the general action is to regulate metabolism like the protein, fat, and
carbohydrates necessary for production of energy.
- Calcitonin - its general function is to carry calcium from blood to bones.
- Parathyroid hormone - it is the opposite of calcitonin, which moves calcium from

bones if the levels of calcium get low in the blood.
3. Protrusion of the eyes is called exophthalmos. How is it related to thyroid
dysfunction? What causes it?
It is related to thyroid as It is a sign of hyperthyroidism. As we all know that
Hyperthyroidism is the overactive thyroid, where it releases high levels of thyroid
hormone into our body. It also causes a speed up of metabolism just like what happened
in the scenario. Symptoms of hyperthyroidism include a rapid heartbeat, weight loss,
increased appetite and anxiety.
The cause of this condition is Grave's Disease, it is an autoimmune disorder. The

antibodies will bind to the thyroid cells that increases the production of thyroid hormone
which may cause overactive Thyroid. Another possible cause is thyroid dysfunction. The
pituitary will release TSH or thyroid stimulating hormone, that stimulates the production
and release of Thyroid hormone. The negative feedback will normally loop that may
cause the signal for the Hypothalamus to release TRH to stop producing TSH to stop
stimulating the TH.
4. What is the significance of the slight swelling in Ellie's neck?

The significance of the slight swelling in Ellie's neck is caused by goiter. Goiter
manifests where the thyroid is located in the neck area. Goiter means that the swelling
happened that can be a sign of both Hyperactive and Hypoactive thyroid.
5. Based on the information you have at this point; do you think Ellie's thyroid gland is
hyperactive or hypoactive? Explain your answer.
Based on the information that I gathered, Ellie's thyroid glands are Hyperactive. As
evidenced by the scenario that her thyroid secretes too much hormone that manifest
signs and symptoms by Ellie's. It is also stated by the scenario that her blood pressure
and heart rate are both high signifies that her thyroid is stimulating too many hormones.
Remember that the B1- beta1 are adrenergic receptors that are found on cardiac cells.
These adrenergic receptors will cause release of Epinephrine and nor-epinephrine,
which make the blood pressure and heart rate rise.
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?
Of course the result would be high in T3 and T4 levels if she has hyperactive Thyroid,
and her TSH levels would be low. On the other hand, If the T3 and T4 level is low and
TSH is not elevated, the pituitary gland is more likely to be the cause for the
hypothyroidism or she has Hypoactive Thyroid.
PART 3
1. What is causing Ellie's thyroid to secrete too much hormone?
The cause of Ellie's thyroid to secrete too much hormone is Grave's disease. The
antibodies are attacking the Thyroid which results in the Thyroid to overproduce TH.
2. Is Ellie correct in thinking that TSH is a thyroid hormone? Why is her TSH level low
instead of high?
No, remember the difference between hormones and stimulating hormones. When the
level of our thyroid hormones (T3 & T4) drops too low, the pituitary gland will produce
Thyroid Stimulating Hormone (TSH) that helps stimulate the thyroid gland to produce
more hormones. Under the influence of TSH, the thyroid will manufacture and secrete
T3 and T4 thereby raising their blood levels. The thyroid stimulating hormone is not a
hormone, but a stimulating hormone necessary for the production of hormones. The
TSH is released by the anterior pituitary to stimulate the thyroid to release hormones. In
the scenario, her TSH level is low instead of high simply because she is producing too
much T3 and T4 hormones, which is telling the Hypothalamus to stop production of
TRH, which would inhibit the production of TSH.
PART 4
1. Ellie is a -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.
The average age of onset is between the ages of 20 and 40 years most common in
women. It is usual for the age of Ellie's to have Graves' disease, but it is unusual to have
a high production of thyroid hormones in our body as it may lead to Graves' disease.
Remember that it can occur in both men and women even if it is most common in
women. The thyroid gland enlarges (called a goiter that makes excessive amounts of
thyroid hormone, causing symptoms of hyperthyroidism.
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?
Beta-blockers like propranolol are helpful as an initial treatment for Graves' disease as it
is frequently prescribed to help prevent heart disease and high blood pressure. It is also
used by most patients to help alleviate the heart palpitations and muscle tremors that
characterize Graves' disease.
The Beta blocker has no effect in reducing thyroid hormone levels. What beta blocker
do is to counter the effects of the hormones. These drugs block the effect of the thyroid
hormone but don't have an effect on the thyroid itself, thus beta blockers do not cure the
hyperthyroidism and also do not decrease the amount of thyroid hormone being
produced.
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.
a. Anti-thyroid medications (methimazole, propylthiouracil)—these medications slow the

production of thyroid hormones.
Advantages: No surgical intervention happened that may cause suffering from the
healing process. Also help prevent the thyroid from producing hormones.
Disadvantages: Effective in relieving symptoms within a few weeks, hyperthyroidism
may return after the drug is stopped.
b. Radioactive iodine—a stronger dose of radioactive iodine is given to gradually destroy

the thyroid gland.
Advantages: Unlike antithyroid medications, the radioactive iodine is a permanent and
more reliable cure for hyperthyroidism. Also, Radioactive iodine therapy can destroy all
or part of the thyroid gland, depending on need.
Disadvantages: Metallic taste in your mouth, dry mouth, sore throat, neck pain, nausea
or vomiting, which is usually mild, constipation or diarrhea, fatigue, and unusually low
(hypothyroidism) or unusually high (hyperthyroidism) thyroid levels.
c. Surgery—part or all of the thyroid gland is removed.

Advantages: It is the most rapid and consistent method of helping the patient euthyroid.
It also avoids the possible long-term risks of radioactive iodine.
Disadvantages: Surgical intervention happened that may cause suffering from the
healing process. Removal of thyroid, and tissue damage.
References:
Douglas R. (2021). HYPERTHYROIDISM CAUSES. UpToDate. Retrieved from:

https://www.uptodate.com/contents/hyperthyroidism-overactive-thyroid-
beyond-the-basics
James N. (n.d.). Hyperthyroidism: Overactivity of the Thyroid Gland. Endocrine Web.

Retrieved from:
https://www.endocrineweb.com/conditions/hyperthyroidism/hyperthyroidism-overactivity-
thyroid-gland#:~:text=These%20drugs%20block%20the%20effect,prevent
%20some%20of%20the%20symptoms.
Vanputte, Regan, & Russo. (2019). Seeley's Essential of Anatomy & Physiology. Mc
Graw Hill Education. Tenth Edition.

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Questions

- T3 Triiodothyronine - is a 3 iodine that is very potent. It acts by modifying the genes

- Calcitonin - its general function is to carry calcium from blood to bones.

- Parathyroid hormone - it is the opposite of calcitonin, which moves calcium from

The cause of this condition is Grave's Disease, it is an autoimmune disorder. The

4. What is the significance of the slight swelling in Ellie's neck?

a. Anti-thyroid medications (methimazole, propylthiouracil)—these medications slow the

b. Radioactive iodine—a stronger dose of radioactive iodine is given to gradually destroy

c. Surgery—part or all of the thyroid gland is removed.

Douglas R. (2021). HYPERTHYROIDISM CAUSES. UpToDate. Retrieved from:

James N. (n.d.). Hyperthyroidism: Overactivity of the Thyroid Gland. Endocrine Web.

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