Write a research paper on the treatment of hyperthyroidism by endocrinologists.You are shadowing an Endocrinologist who has two last-minute patients who seem to be having
a medical emergency similar to a Thyroid Storm. Both were admitted to the ER, and their
symptoms of elevated BP, tachycardia, elevated body temperature of 103.4 oF, delirium, and
dyspnea (difficulty breathing) were now under control. The two patients, Jessica and Anthony,
arrived at the ER within minutes of one another. They are not related, and don’t know each other.
They have very similar symptoms as well as medical histories:
Given that Thyroid Storm is incredibly rare, the Endocrinologist feels that these two patients
coming in at the same time is a coincidence, and he will (and you will) run the DDX for each
patient separately. There are many possible options for thyrotoxicosis (hyperthyroid) conditions.
For this case study, limit your DDX to the following list of possibilities:
DDX 1: granulomatous disease (i.e. sarcoid); tertiary pathology
DDX 2: multifocal thyrotroph hyperplasia; secondary pathology
DDX 3: Thyroid (colloid) nodules; primary pathology of a benign growth of thyroid tissue
DDX 4: Thyroid cancer; primary pathology of a malignant growth of thyroid tissue
DDX 5: Graves’ Disease (discussed in lecture); autoimmune pathology
DDX 6: Hepatocellular carcinoma secreting TSH
DDX 7: Struma ovarii (dermoid ovarian cysts secreting hCG, which can bind TSH receptor)
DDX 8: Factitious (ingesting exogenous synthetic T3/T4 ex: Synthroid)
DDX 9: Taking Drug X for hypertension (causes increase in NIS expression in thyroid gland)
DDX 10: Non-hyperthyroid toxicosis (rapid destruction of entire thyroid gland = rapid release of
colloid and T3/T4); due to malignant neoplasm, usually breast or lung carcinoma metastasis
The first part of the DDX is to run a standard Thyroid panel (as discussed in lecture) and blood
panel (CBC and basic metabolic panel). The results for both Jessica and Anthony are startlingly
similar—their numbers match up exactly on the thyroid panel. There were no flags in any of the
CBC (slightly elevated white blood cells, but not outside of the bounds of normal) or metabolic
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