The Case of the Sweaty Salesman – Michael is a 30-year old salesman who spends approximately 4 days each week traveling to visit with customers in his region. During his routine physical he casually mentions to his physician that he seems to be sweating more profusely than normal and most rooms that once were comfortable are now too “hot”. He thought that it was simply due to the change in seasons and companies being slow to turn down the thermostats from the winter temperatures, however this problem seems to persist even when he is at home. A room that his wife and children find to be comfortable causes him to sweat profusely. Michael also reports that he seems to be loosing weight even though his appetite has increased. He also complains that he has a shortened attention span and that he always wants to be moving around. Despite the fact that he feels fatigued, Michael claims to have difficulty sleeping and seems to have more frequent bowel movements, occasionally accompanied by diarrhea. The physician checks Michael’s medical history and finds that indeed he has lost 15 pounds since his last physical. Wanting to rule out the possibility of infection with the human immunodeficiency virus (HIV), the physician asks Michael questions about his sexual history and practices and finds that he is not at risk for HIV infection. Also in checking his chart, the physician finds that Michael has a negative history for chronic illnesses, does not smoke, and has a low risk for cardiovascular disease. He does however have a positive family history for autoimmune diseases. His father suffers from idiopathic thrombocytopenia, his mother has been diagnosed with rheumatoid arthritis and his oldest sister was recently diagnosed with systemic lupus erythematosus.
Results of Michael’s physical examination were within normal ranges with the exception of the following: he demonstrated tachycardia, loud heart sounds, and apparent cardiac arrhythmias accompanied by slight hypertension. These arrhythmias were confirmed by electrocardiogram to be supraventricular in origin. Michael’s eyeballs appeared large and protruding and his hair was fine and soft. He was also beginning to demonstrate some degree of alopecia. Michael was also observed to have palmar erythema. Palpation of the neck revealed the presence of goiter. Results of blood tests indicated elevated concentrations of thyroid hormones (thyroxin and triiodothyronine), hypercalcemia, and decreased circulating concentrations of lipids. Based on the physical characteristics and the results of the blood tests, Michael’s physician suspected that Michael was suffering from some form of hyper-thyroidism and sent him to an endocrinologist to confirm the initial diagnosis.
Following the initial consultation and examination, the endocrinologist ordered tests to determine whether Michael was indeed hyperthyroid. The test results indicated an elevation in the concentration of thyroid hormones in the blood and the presence of thyroid-stimulating antibodies. These antibodies specifically stimulate the thyroid gland by binding with the thyroid stimulating hormone receptor located on the plasma membrane of the follicular cells of the thyroid gland. Based on these results, the endocrinologist concluded that Michael had Grave’s disease, a form of hyperthyroidism believed to be autoimmune in nature. Michael was presented with a number of possible treatment options. These included treatment with chemicals (propylthiouracil and methimazole) that decrease the production of thyroid hormones by the thyroid gland, radioisotopic destruction of the thyroid gland by the use of 131I, and surgical removal of the thyroid gland. After considering all the options, especially the possible effects of radiation on gamete development, Michael chose surgery. Following successful surgery, Michael was prescribed synthetic thyroid hormone to ensure that his body was receiving adequate thyroid hormone and told to return within 2 months for a follow-up evaluation of circulating thyroid hormone concentrations. He was also cautioned to carefully monitor his calcium intake.
1 Define the bold terms in the text.
2 Thyroid hormones exert their effects on cells in a manner similar to steroid hormones; describe the mechanism of action of thyroid hormones.
3 Evaluate why an imbalance in thyroid hormones have such widespread effects on the body?
4 Propose two ways that allow diagnosis of Michael’s symptoms as goiter.
5 Analyze why calcium homeostasis would be impaired in response to removal of the thyroid gland?
6 Explain why 131I could be used to specifically destroy the thyroid gland and have minimal effects on other cells and tissues in the body?
7 Knowing that Michael and his wife may want to have more children infer/ explain why it was ruled out to use highly radioactive isotope for the destruction of the thyroid gland ?
8 Define the terms ‘Graves Disease’ and ‘goiter’ and explain what causes ‘each. [Goiter has more than one cause.]
Since all our papers are written from scratch, the papers we submit are plagiarism free and we strictly adhere to lecturer’s instructions. Our writers are highly qualified from all over the world and include graduates and professors from most of the largest and known universities in the world. Once you have assigned us your assignment, we select the most qualified and reliable writer to handle your assignment.
Unlike other writing companies, we encourage clients to draw back their money at any stage of the writing process if they experience any uncertainties with the quality of generated content. However, you will hardly have to make this decision because of our business approach that suits your needs.
We have an advanced plagiarism-detection system that flags any work that fails to meet the required academic expectations. Our company thrives in honesty, and as such, you will be guaranteed to achieve a paper that meets your expectations.
At homeworkpaper.org we have online agents that you can chat with to have your assignment taken care of with the little remaining time. Also, we have professional academic writers who will work on your assignment providing you with a high-quality paper at the same time. We can take care of your urgent assignments in less than 5 hours.
We uphold confidentiality and privacy through our interactions with clients, an aspect that has enhanced our relationship with prospective customers seeking for assignment help. We do not disclose your information with third-parties; neither do we share your work with any other person apart from you.
We do not resell previously-done tasks delivered to other clients. When we deliver orders to our clients, we safeguard their privacy and confidentiality by ensuring the third party does not access the work. By writing the papers from scratch, we have managed to maintain a certain level of originality, which defines our business model. Our qualified editors proofread all submitted work to eliminate mistakes that can interfere with the credibility of the assignment.