Block 2 Case 2 Answers

Female patient presents with tachycardia and weight loss. She is notably anxious and has difficulty concentrating. She has been suffering from insomnia. She also notes an increase in appetite and persistent diarrhea.

1. What would the the thyroid function tests look like? TSH low and T4/T3 high

2. Why are her eyes bulging? Ptosis and muscle weakness is noted because adipose and glycosaminoglycans are deposited within the tissue.  (note: when glycosaminoglycans are in excess in the dermis this causes pretibial myxedema. 

3. What type of hypersensitivity is reaction is present in this disease? Type 2 due to anti-TSH receptor antibodies

4. Describe her biopsy: 

Hyperplastic epithelium with lymphocytic infiltrate causing a diffusely enlarged gland. Note the scalloping of the colloid. Tall columnar epithelium lines the infolding. The colloid is expanded due to the increase synthesis of  thyroid hormone.

normal thyroid: http://biology.clc.uc.edu/fankhauser/Labs/Anatomy_&_Physiology/A&P202/Endocrine_System/histology_jpgs/thyroid_400x_P2252255lbd.JPG

4. What does she have? Graves