Download Hashimoto`s disease or Graves` disease

TBL – Task Based Learning
TASK: Problem solving – You are a doctor. A patient comes in with signs of cachexia, very agitated, heart
palpitations, and exophthalmos. Which of the following choices best describes her condition?
Diagnosis :
A) she has Hashimoto’s hyperthyroidism with low TRH and TSH levels.
B) she has Hashimoto’s hyperthyroidism with high TRH and TSH levels.
C) she has Hashimoto’s hypothyroidism with low TRH and TSH levels.
D) she has Hashimoto’s hypothyroidism with high TRH and TSH levels.
E) she has Graves’ hyperthyroidism with low TRH and TSH levels.
F) she has Graves’ hyperthyroidism with high TRH and TSH levels.
G) she has Graves’ hypothyroidism with low TRH and TSH levels.
H) she has Graves’ hypothyroidism with high TRH and TSH levels.
You must use your mobile phones to search for all the information you need.
__________
Main linguistic structures involved:
defining, comparing, contrasting, hypothesizing, explaining.
Students will use all four language skills.
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Solution: next page
Solution of the problem solving task
TRH (thyrotropin-releasing hormone): produced and secreted by the hypothalamus, it induces the releasing
of the pituitary hormone TSH.
TSH (thyroid stimulating hormone): produced and secreted by the anterior pituitary, it induces the
production of thyroid hormones T3 and T4, which stimulate our metabolism.
If the plasmatic levels of T3 and T4 are too high, we have an iperfunctioning of the thyroid gland
(hyperthyroidism), which induces cachexia (excessive weight loss without apparent reasons), exophthalmos
(protruding eyes), heart palpitations, agitation: the symptoms of our patient (the symptoms are the opposite
if their level is too low). So she is suffering from hyperthyroidism (in this way, we can eliminate the
options C, D, G, H). At this point, we have to decide if she is suffering from Hashimoto’s disease or Graves’
disease.
Hashimoto’s disease:
Graves’ disease:
They are both
autoimmune
diseases: our
antibodies attack
our own body
antibodies attack and destroy the
thyroid gland, so it cannot produce
and release T3 and T4. Hypothalamus
detects the low levels of thyroid
hormones and thus it releases TRH
(negative feedback): in this way,
pituitary is stimulated to produce
TSH, and so the thyroid strives to
produce its hormones T3 and T4, but it
cannot do it because of the
Hashimoto’s disease. The cycle
begins again: in this way, TRH and
TSH plasma levels increase, while T3
and
T4
levels
are
low
(hypothyroidism, whose symptoms
are opposite to those of our patient).
She does not suffer from the disease
of Hashimoto: we can eliminate the
options A and B.
antibodies attack and stimulate the thyroid
gland, so T3 and T4 blood levels increase.
Hypothalamus detects the high levels of
thyroid hormones and thus it does not release
TRH (negative feedback): in this way,
pituitary is not stimulated to produce TSH,
and so the thyroid should stop producing T3
and T4, but it cannot do it because of the
Graves’ disease. The cycle begins again: in
this way, TRH and TSH plasma levels
decrease.
So, the Graves’ disease is characterized by
high plasma levels of T3 and T4, and low
plasma levels of TRH and TSH.
The only possible options are E and F. The
correct one if the option E.
Diagnosis :
she has Graves’ hyperthyroidism
low TRH and TSH plasma levels.
with