SGD - 4

ENDO II

Case:
A 24 year old white female comes to her family doctor because of weight loss
despite having a good appetite; she also complains of increasing anxiety.
She admits to having frequent bouts of diarrhea, reduced sleep capacity, heat
intolerance, sweaty palms, palpitations, tremors and menstrual irregularity.

Physical examination:
Vital signs: tachycardia.
Tremors of outstretched hand; warm, moist skin; right lobe of thyroid palpably
enlarged; left lobe not palpable; no evidence of retrosternal goiter; no cervical
lymphadenopathy.

Laboratory tests:
Decreased plasma TSH; increased free T4 and T3; antihydroperoxidase antibody
absent

Imaging:
Nuc: hyperfunctioning hot thyroid nodule
Diagnosis: Plummer‟s nodule
Questions:
1. What is Plummer‟s nodule? "

Plummer 's nodule , also known as Toxic multinodular goitre

"
is a
type of
goiter where in the thyroid gland contains multiple autonomous
nodules w/o results to
functioning
hyperthyroidism due to overproduction of

thyroid hormones .

2. Differentiate the following conditions as to causes and hormonal picture:

A. Primary hyperthyroidism
Caused by overproduction of thyroid hormones Tg 'T Ty , due to an autoimmune
-

process that interferes w/ the negative feedback mechanism or

of
uncontrolled
growth hormone producing functional tissue In this disease .

Tz 'T Tt is increased while TSH and TRH are low .

B. Secondary hyperthyroidism
caused
by overstimulation of the thyroid due to either
-

increased production of TSH from the

Pituitary gland or

by an
TSH secreting tumor In this syndrome Tz Ty
.

and TSA
,
is increased while TRH is decreased ,

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 C. Tertiary hyperthyroidism
which
A
type of
hyperthyroidism when the
hypothalamus
-

occurs

secretes excess
thyroid releasing hormone This type
of
hyperthyroidism has Tz Ty Ts HI TRH all
.

increased in
secretion , , ,
.

3. Give the MOA of thyroid hormones.

Thyroid hormones
namely Tz 'T Te stimulates diverse metabolic activities
, ,

host tissues leading to increase in basal metabolic rate A consequence

an .

of this activity is to
increase body heat production which seems to result at
least in part from increased oxygen consumption
, and rales of Atp
hydrolysis
4. Discuss the presence of the following:
A. Weight loss
-

thyroid nodules produce additional thyroxine hormones secreted by the ,

thyroid gland body to regulate functions like metabolism . Excess thyroxine causes
enhanced metabolism resulting to
weight loss .

B. Diarrhea
like in weight loss
-

thyroxine enhances the body 's metabolism therefore

,

speeding up digestion wk results to diarrhea

C. Tachycardia, palpitations
-

Tachycardia and palpitations is experienced by the patient for

thyroid hormones increase the heart rate of person And due to the patient a

having nodules that produce thyroxine thyroxine

.

, there will be an excess

D. Heat intolerance, warm and moist skin
Due to increase
body metabolism , the
body temperature rises to compensate
-

and also resulting to warm # moist skin .

5. What does a hyperfunctioning hot nodule mean? What is the effect on the
surrounding tissue and right lobe of the thyroid gland?

Hyper functioning hot nodule that the nodules

autonomously
means

produce thyroid hormone without regard for normal feedback control

mechanisms wlc
may lead to the development
, of
hyperthyroidism

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 continuation of the case:

Surgery was done on the patient to remove the nodule. Immediately after
surgery, the patient developed spasm of the muscles of the face and extremities
followed by spasm of the muscles of the trunk.

Physical examination:
Positive Chvostek‟s sign
Positive Trousseau‟s sign
Laboratory exam:
Plasma calcium = 4 mg/dL
Question:
6. What happened to the patient?
-

The patient 's parathyroid gland was damaged during the.

surgery therefore PTH ,

or
parathyroid hormone levels decreases
the ,

resulting to low blood calcium level or hypercalcemia

7. How are the Chvostek‟s sign and Trousseau‟s sign elicited?
Chro stele 's
sign is the twitching of the facial muscles in
response to tapping over the area of the facial nerve .

Trousseau 's
sign is carpoped al spasm caused by inflating the blood
a

pressure cuff a level above

systolic pressure for 3 minutes .

8. Give the biologic actions of:

A. PTH Is the most endocrine
important regulator of calcium and
-

phosphorus concentration in extracellular fluid The

or PTH
increases the calcium levels in the blood
Parathyroid
. hormone

mobilization of calcium from bone

by stimulating 3 processes ,

intestine and
, enhancing absorption of calcium from the small
suppression of calcium loss in urine
B. Vitamin D
-

is a hormone involved in mineral metabolism and bone growth .

Its most
important effect is facilitate intestinal
to
it stimulates absorption of calcium although ,

absorption of phosphate f magnesium ions

C. Calcitonin -
is a
peptide hormone produced by the C cells of the thyroid
gland Its main biological effect is to inhibit bone
resorption
.

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9. Differentiate the following conditions as to causes and hormonal picture:

A. True hypoparathyroidism
of
type hyperparathyroidism
where in it be caused by either
-

may
hypoplasia / congenital absence of
accidental removal of it This type
the
of
parathyroid gland and also an
parathyroid ish involves a decrease
.

in PTH bone resorption Vit D formation Intestinal absorption of Calcium

,
.

, ,

and Phosphate and kidney resorption of Catt It Phosphate

excretion
also involves . increase

B. Pseudohypoparathyroidism
of
type hyperparathyroidism where in there is resistance to PTH
-

due to diff
namely
inert PTH, PTA inhibitors in the
l PTH receptors
. reasons
body and abnormality
w
Normal hormone levels in the body but the
kidney does not
.

work properly therefore resulting to Calcium excretion decrease calcium or a

in the body and
increase in Phosphate because excretion of it is not
an

present .

C. Primary hyperparathyroidism

type of
hyperparathyroidism where in it be caused
by adenoma,
-

may
primary hyperplasia and parathyroid carcinoma . An increase in PTH can
be encountered here
leading to increased osteoclasts c and osteoblast c
'
'

activity .

D. Secondary hyperparathyroidism
of
type hyperparathyroidism where in it be caused
by any condition
-

may
that can result to chronic hypercalcemia which in turn , causes compensatory
Over
activity
intake of calcium Sfeatorrhea
of the parathyroid
gland
Here renal failure .

, inadequate
and , deficiency in Vitamin D are some of its
causes .

A decrease in calcium ¥ Vitamin D PTH and

increase in
increase
-

an an
decrease
, or
in
phosphate can be encountered w/ this
disease

This material is downloaded for Richmond A. Amurao (20200015401)

at FEU Dr. Nicanor Reyes Medical Foundation.
For personal use only. No other uses without permission. All rights reserved.
143