Once again, Lucy sat in the exam room waiting on Dr. House. He flew in the door,

Question

Once again, Lucy sat in the exam room waiting on Dr. House. He flew in the door, grabbed a stool and, to Lucy’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. Those 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.”

Lucy’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 Professor Forson’s Biol& 242 class!

“Well, maybe,” Dr. House 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. The good news is that with treatment patients report an improvement in their cognitive abilities, regardless of the underlying cause.”

Lucy felt a twinge of relief. “Oh, good! That 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?”

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

Questions

1.What is causing Lucy’s thyroid to secrete too much hormone?

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

Explanation / Answer

1. Lucy's thyroid is secreting too much hormone because of irregular and fast heart rate, rapid pulse, anxiety, insomnia, decrease tolerance of heat, tremor, etc. She also may have puffy eyes or mood swings.

2. No Lucy is not correct. TSH (thyroid stimulating hormone) is a pituitary hormone produced from anterior part of the pituitary gland. It stimulates thyroid gland in order to produce the two thyroid hormones T4 and T3.

However, TSH levels are low in order to compensate the levels of T4 and T3 hormones.

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