Case Study 1 Part 1,2,3 - Frustration Ellie dropped her backpack

Case Study 1

It’s Just Stress, Right? A Case Study on the Endocrine System by Sheri L. Boyce Department of Biological Sciences, Messiah College, Grantham, PA

Part I – Frustration Ellie dropped her backpack beside the chair in Dr . Kern’s office and sat down with a sigh. Her hands trembled as she glanced again at the graded exam in her hand.

“It’s no better than the last one,” she mumbled. “I really, really tried this time, Dr. Kern. I did all the reading assignments before and again after class. I completed all of the study guide questions and rewrote my notes and made flash cards and studied with straight-A Cassie every week. But it didn’t make any difference. I still failed it.” She sniffled loudly and reached for the box of tissues on Dr. Kern’s desk.

Dr. Kern sat back and thought for a moment while Ellie made use of several tissues. Ellie was a junior in Dr. Kern’s physiology course and had struggled from the start of the semester. One-on-one help sessions and different study strategies hadn’t seemed to help. “I know how discouraged you must be, Ellie. Tell me again what you do when you sit down to study.”

“I read and review my class notes and reread the assigned sections in the book. But for some reason I can’t concentrate on much of anything for very long and, even when I can, I don’t remember what I’ve studied by the next day. It’s so frustrating to spend so much time studying and not retain anything. If I fail this class, my GPA might drop enough that I’ll lose my scholarships. I’m so stressed that I can’t sleep, even when I try.”

Ellie broke off, and Dr. Kern gently tried to encourage her. “Let’s not give up hope yet. Sometimes you have to use new study methods for a while until you start to see some benefits. Let’s also take a look at your exam and see if there’s a pattern in the questions you missed.”

Ellie sniffled again. “OK, but I’m not very hopeful. I’ve been thinking about changing my major. All these upper- level courses seem so hard … there’s so much to learn in such a short time and I just don’t seem to get it even though everyone else does. I can’t stand the stress anymore.”

“Perhaps talking this over with your parents or a trusted friend would help,” Dr. Kern suggested. She noted Ellie’s strikingly large blue eyes that gave her a permanent look of surprise. Ellie was also quite thin, almost to the point of being too thin. Dr. Kern paused and chose her words with care. “I also know there are terrific folks over at the health center who are experts in how to deal with stress. ”

Ellie gave a small, noncommittal smile and pushed a shaking hand through her hair. “Tanks, I’ll think about it. See you in class on Monday.”

However, Ellie didn’t come to class on Monday or Wednesday. She emailed Dr. Kern that she most likely had a sinus infection and would miss class on Friday to see a doctor. Dr. Kern shook her head at Ellie’s misfortune; missing a week of class was not going to make it any easier for Ellie to pull up her grade.

“It’s Just Stress, Right?” by Sheri L. Boyce Page ?

Questions

?. Note anything unusual about Ellie’s behavior or appearance.

?. What do you think might be going on with Ellie that could cause her diffi culties? Consider both physical and psychological causes.

“It’s Just Stress, Right?” by Sheri L. Boyce Page ?

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 annoy-?? gniyear-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. Tis 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? Did she consume table salt frequently

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?”

“Tey 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. Tat 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 fi nd.”

He scribbled a lab order and smiled kindly. Ellie grabbed the papers and left, feeling worse than when she first came in.

Questions

?. Where is the thyroid gland located?

?. List the hormones secreted by the thyroid and describe their general actions.

?. Protrusion of the eyes is called exophthalmos. How is it related to thyroid dysfunction? What causes it?

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

“It’s Just Stress, Right?” by Sheri L. Boyce Page ?

5. What is a goiter and how are these structures formed?

Part III – Thyroid Trouble Once again, Ellie sat in the exam room, eating her favorite salty snack, waiting on Dr. Simmons. He flew in the door, grabbed a stool and, to Ellie’s relief, got right to the point. “Well, your blood work does show some problems with your thyroid. Your TSH levels are lower than they should be, your T4 levels are a bit high and your T3 levels are very high. Tose results suggest that you might have Graves’ disease, which means that your thyroid is releasing too much thyroid hormone. Since thyroid hormones are responsible for your metabolic rate, that explains why your heart rate and blood pressure are elevated, why you’ve felt nervous and can’t sleep, and why you’ve lost weight even though you aren’t dieting.”

Ellie’s mind whirled. “Sooooo, could this also be why I can’t concentrate when I try to study and why I can’t seem to remember anything?” Maybe there was still some hope for her in Dr. Kern’s physiology class.

“Well, maybe,” Dr. Simmons answered. “Some studies suggest that excess thyroid hormone is correlated with decreased attention, concentration, and working memory. In other words, your thinking might not be as clear as it should be. However, other experts argue that it’s the anxiety and nervousness that cause patients to feel their thinking is impaired, even though there is no actual impairment. Te good news is that with treatment patients report an improvement in their cognitive abilities, regardless of the underlying cause.”

Ellie felt a twinge of relief. “Oh, good! Tat will certainly help my grades. But why is my thyroid releasing too much hormone? And you said my TSH levels were low. Isn’t TSH a thyroid hormone? If my thyroid is too active, shouldn’t it be high instead of low?”

Ellie has just asked some very good questions. If you were Dr. Simmons, how would you answer her?

Questions

.?What is causing Ellie’s thyroid to secrete too much hormone? (Use your textbook to answe

.?Is Ellie correct in thinking that TSH is a thyroid hormone? Why is her TSH level low instead of high?

“It’s Just Stress, Right?” by Sheri L. Boyce Page ?

Dr. Simmon decides to take a surgical biopsy of Ellies thyroid gland. The result revelead that Ellies thyroid gland is normal.

Questions 1. Using the thyroid gland image to the left. Identify the following structure: Thyroid Gland

(Use your textbook to answer this question)

“It’s Just Stress, Right?” by Sheri L. Boyce Page ?

2. What is Grave's Disease?

3. What role does the hypothalamus play in stimulating the anterior pituitary gland to release TSH

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