Explain the physiological role of thyroid hormones and relate to the main signs and symptoms of hyperthyroidism (must identify which are considered signs and which are symptoms)

Summative assignment BMS2515A 1500± 10%

word essay discussing the following clinical case Assignment assesses LOs 1, 4 &5.Release date:

week 10Case scenario:

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Shannon is a 32 year old female. She works at the local Community Mental Health ServiceCentre. She states that “nowadays my patients are often in a better mental state than I am!” She complainsthat during the past few weeks her life has changed beyond recognition. She is constantly tired, anxious and apprehensive. She is finding it increasingly difficult to cope with her work load. Shereports a change in her appetite and had noticed that she lost a few pounds. She noticed that hereyes are increasingly protruding and “feel like they are filled with sand”. There are occasionalepisodes of diarrhoea, vomiting and palpitation

.Medical history:Shannon has type I diabetes which she developed at the age of 15. Her condition is under control andher blood sugar level is within expected levels.

Upon physical examination: BMI of 17.5 kg/m2. She is wearing a light T-shirt and appears sweatyand red-faced in spite of the cold weather.

Vital signs:increased resting pulse rate, systolic hypertension and tachypnoea.

Neck examination reveals a diffusely enlarged non-tender thyroid. The patient has a fine tremor of the hand and tongue. Deep tendon reflexes are increased. Opthalmological examination shows lidlag with normal motion.

Laboratory studies were remarkable for free T4: 37.8 pmol/L(10-20 pmol/L), thyroid stimulatinghormone (undetectable) < 0.01 mU/L (0.5-5 mIU/L), detection of significantly elevated levels of TSHreceptor antibodies (TRAb)and slightly elevated antithyroglobulin antibodies. A thyroid scan showeda diffuse increase in trapping and a moderately enlarged gland

.CBC, LFTsand RFTs were unremarkable

.The physician suspects Graves ’disease.For your assignment, you will take the role of the physician and through answering the questionsbelow, you will offer your reader an overview of the disease and a justification for diagnosing thecase asGraves ’ disease.

Questions:1-Define thyrotoxicosis/hyperthyroidismand mention its common causes

2-Explain the physiological role of thyroid hormones and relate to the main signs and symptoms of hyperthyroidism (must identify which are considered signs and which are symptoms)

3-Explain the rationalebehind the current diagnosis and evaluate the available evidencethat supports this diagnosis.

4-Briefly discussthe pathophysiology of “Graves’disease”

5-Briefly,discuss the treatment options available for this condition.6-Highlight some of the possible complications that could arise in this case.Guidelines for writing your case report:

Your case report should be written in the form of an essayaddressing the above questions. If you prefer to use subheadings for each section of your essay, you can do so to help you organize your writing. If you decide to use subheadings, please do not use the questions themselves as subheadings. You should comeup with an appropriate subheadingfor each section of the assignment. The first paragraph of the essay should ideally bean introduction to hyperthyroidism including a definition and a summary of its generalclassification. The following paragraphs should answer the questions given above in a logical and organised manner with an attempt to make a smooth transition from onetopic to another creating a systematic and meaningful interpretation of the case.When answering

Q2, remember that you are discussing thegeneralsymptoms of the disease. Your answer should reflectyour understanding of the origin of the clinical picture.You are not required to provide an interpretation of each symptom and sign but you are expected to categorize groups of signs and symptoms and relate them to the disturbance of a particular function of thyroid hormones. It is useful to mention whether the condition could have different presentations(atypical), type of onset,etc.When answering

question3(relate to the case) you should show clear understanding of the diagnostic value of the tests.Explainto the reader how you plan to reach a diagnosis, group your test results to reach a particular conclusion, etc. You need to project an understanding of how the tests are collectively interpreted. All tests mentioned should be addressed even the tests showing normal results( why was the test/tests done?).Your argument should explain the reasons for choosing a diagnosis over another (why is it Graves and not any other form of hyperthyroidism?)

Your essay should provide a scientifically based argument of the case. Appropriate references should be cited in text and a reference list should be provided at the end of the essay. Please, follow departmental guidelines as to how to style and order your references. You can also refer to http://www.citethemrightonline.com/for further guidance on referencing. (use Harvard system)It is strongly recommended NOTto use patient directed websites as references (NHS.com, boots.com, mayo clinic .com). The use of these websites as main sources of information always results in an assignment that is superficial, including inaccurate data and of poor academic standard

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