CASE Study

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Case Study 4.2 – Autoimmune Thyroid Disease

Compare the immunopathogenesis, morphology, and clinical features.

For your INITIAL POST, students with the LAST name beginning with the letter:

  • A – C: Will answer Questions 1A #1 & 1B #2
  • D – F: Will answer Questions 1A #2
  • G – J: Will answer Questions 1A #3
  • K – O: Will answer Questions 1A #4
  • P – T: Will answer Questions 1A #5
  • U – Z: Will answer Questions 1B #1
  • Initial posts and responses must be based on various resources such as textbooks, articles, and journals. Medscape, Up-to-Date, and ePocrates as supplemental resources are acceptable.

“NB LAST NAME IS RACHFORD”

 

The following images may help guide your discussion:

Case 1A

A 43-year-old woman presents with a 2- to 3-month history of nervousness, increased sweating, decreased tolerance to heat, palpitations, fatigue, weight loss with increased appetite, and increased bowel movement frequency. She also has puffiness around her eyes and noted episodes of double vision, also of 2 to 3 months’ duration. She is otherwise healthy, takes no medications, and leads an active working life. This is her first episode of hyperthyroidism.

Palpation of her neck reveals a diffusely enlarged thyroid gland, representing a goiter of 70 to 80 gm. She has a pulse of 105 beats/min and typical but minimal eye signs. Serum levels are triiodothyronine, 354 ng/dL (reference range 52-160 ng/dL); thyroxine, 13.9 μg/dL (reference range 5.5-12.3 μg/dL); TSH, <0.05 μU/mL (reference range 0.05-5 μU/mL); and free thyroxine, two ng/mL (reference range 0.7-1.8 ng/mL).

Questions for Discussion:

  1. What is the cause of the patient’s symptoms? What kind of hypersensitivity is involved?
  2. What are the etiology and mechanism of Graves disease?
  3. What consequences does this disease have histopathologically in the thyroid gland?
  4. What is the significance of the laboratory values?
  5. Describe the primary extrathyroid manifestations of this disease briefly: ophthalmopathy and dermopathy.

Case Study 4.1 – Anemias of Diminished Erythropoiesis

 

Gigi, a 14-year-old female presented to her pediatric practitioner with increasing fatigue and weakness. She recently began experiencing shortness of breath with performance of routine physical activity. Gigi had no personal or family history of anemia, unusual dietary habits, or bleeding. On physical examination, pallor and tachycardia were noted without other abnormal findings. Selected laboratory studies are listed. Complete Blood Count (CBC)

Hemoglobin (Hb):

6.6 gm/dL

Red cell distribution width (RDW):

21.5%

Reticulocytes:

0.7%

Erythrocytes:

3.4 x 106/mm3

Leukocytes:

8,100/mm3

Mean cell volume (MCV):

68 µm3

Platelets (Plt):

480,000/mm3

Mean cell hemoglobin concentration (MCHC):

28.7 g/dL

Microscopic examination of the peripheral blood smear revealed red blood cell changes, as seen in Image 1. Additional laboratory work was ordered. The results of these studies are as follows:

Additional Lab Work

Total serum iron (TSI):

20

Total serum iron binding capacity (TIBC):

400

Transferrin saturation:

5%

Serum ferritin:

12 ng/mL

The following images may help guide your discussion

Links to an external site.ALL students will answer Question #1, and Question #13.  Then for your INITIAL POST, students with the LAST name beginning with the letter:

A – C: Will answer Questions 12

D – F: Will answer Questions 2 & 7

G – J: Will answer Questions 3 & 8

K – O: Will answer Questions 4 & 9

P – T: Will answer Questions 5 & 10

U – Z: Will answer Questions 6 & 11

Initial posts and responses must be based on various resources such as textbooks, articles, and journals. Medscape, Up-to-Date, and ePocrates as supplemental resources are acceptable.

  1. What is the epidemiology of Iron Deficiency anemia? (CDC; WHO; other resources)
  2. Iron deficiency anemia may be characterized as what type of maturation defect?
  3. What is the functional classification of iron deficiency anemia? What is the morphologic classification of iron deficiency anemia?
  4. What is the most common cause of iron deficiency anemia in the United States?
  5. What are the major causes of megaloblastic anemia?
  6. What is the biochemical basis of delayed nuclear maturation in megaloblastic anemias?
  7. What are other causes of macrocytic anemia?
  8. What are the similarities and differences between the effects of folate deficiency and vitamin B12 deficiency? Can these two be distinguished based on changes in the blood smear or marrow aspirate?
  9. Why does the normoblast contain increased mRNA?
  10. What is the pathogenesis of aplastic anemia? How is it treated?
  11. How does pure red cell aplasia differ from aplastic anemia? What are its major causes?
  12. True or False: In iron deficiency anemia, serum ferritin is decreased, allowing distinction from the anemia of chronic disease. Please explain.
  13. What is the Primary Diagnosis?  What are two possible differential diagnoses?  What is the likely outcome of this case?

“NB”

LAST NAME IS RACHFORD