Thyroid Troubles: A Case Study in

Negative Feedback Regulation

Group 13:
Introduction: Ethan Start & Christopher Wach
Diagnosis: Daniqua White & Emily Horak
Explanation: Mark Slusher & Abhishek Malkan
Treatment: Haydon Strable & Adeyinka Ladapo
Conclusion: Camila Villacreses & Drew Brantley
*Case study published in the National Center
for Case Study Teaching in Science journal
by:
Breanna N. Harris Texas Tech
University, Lubbock, TX
Introduction
52 year old African American female
presents to the endocrinology clinic
complaining of:

Not feeling herself for the last 3 months

Feeling cold, tired, fatigued
Gaining approximately 20 pounds while dieting
She is postmenopausal x1 year Next Step
*Patient also states she has no other significant
medical history.
Physician on duty completes physical exam,
findings are within normal limits
Physician explains suspicion of thyroid disease
and orders blood tests to confirm that include:
TSH
T3
T4
 Diagnosis
Based on symptoms described, Dr. Siddiqui suspects a thyroid
issue.

Thyroid gland: Largest pure endocrine gland. Secretes T3 and

T4 hormones, which regulate overall metabolism, triggers
protein synthesis, and promotes maturation of nervous system.
Diagnosis
Hypothyroidism: The condition in which the thyroid gland does
not produce enough thyroid hormone.
Symptoms: Cold all the time, tired, depressed, slow heart rate,
slow reflexes, constipation, weight gain, appetite loss

Hyperthyroidism: This is the overactivity of the thyroid gland,

and produces too much of the thyroid hormone thyroxine.
warm/hot increase in activity, manic, rapid heart rate, frequent
bowel movement, increased appetite, weight loss
 Test Results
Test Result Normal Range

Thyrotropin (TSH) (IU/mL) 0.3 0.5-6

Serum Triiodothyronine (T3), (ng/dl) 57 80-180

Serum Thyroxine (T4) (g/dl) 1.8 4.6-12

The HPT axis is not functioning properly. Low TSH and Thyroid Hormone levels indicate
that the patient has hypothyroidism. We suspect that there is a problem with the
hypothalamus or the anterior pituitary gland.

The patients symptoms are consistent with those of hypothyroidism. These symptoms
indicate an overall decrease in metabolism, and include fatigue, lethargy, intolerance to
cold, and unexplained weight gain.
 Treatment
Synthetic Thyroid Hormone Replacement:
Hypothyroidism is usually treated with Levothyroxine,
a synthetic hormone that is chemically identical to
thyroxine (T4).
Ex: Synthroid 137mcg 1po QD

Risks, benefits, and proper use of medication have

been discussed. Dosage can be adjusted depending
on how she reacts to the medication. Will run another
thyroid panel in 3-4 months.

Treatment is usually lifelong.

 Diagnosis
Possible Diseases Predicts Patient Results
Iodine deficiency Low T3/T4, High TSH Low T3/T4, Low TSH

Graves Disease High T3/T4 Low T3/T4

Hashimotos Disease High antibodies Low antibodies

TRH secreting tumor High TSH Low TSH

TSH secreting tumor High TSH Low TSH

TRH suppressing tumor Low TSH Low TSH

TSH suppressing tumor Low TSH Low TSH

Further Tests
Under normal situations in the HPT axis the hypothalamus
produces the thyroid releasing hormone (TRH)

This then causes the anterior pituitary to release thyroid

stimulating hormone (TSH) which causes the thyroid
gland to release T3 and T4

A hormone suppressing tumor on either the hypothalamus

or the anterior pituitary could compromise this pathway.

In order to determine on which of these this tumor is

located on the patient, it would be beneficial to determine
the levels of TRH,TSH, and thyroid hormones in her blood.
 Further Tests
The Doctor decides to inject the patient with a dose of TRH and then takes a blood sample to
measure the levels of TSH and thyroid hormones. The following chart expresses the
expected amounts depending upon where the tumor is located.

Hypothalamus Anterior Pituitary

TSH High Low

Thyroid Hormones High Low

TSH is made in the anterior pituitary gland. If the hormone-suppressing tumor was present in
the anterior pituitary gland, the TSH levels would be suppressed. Because TSH stimulates the
production of other thyroid hormones, the thyroid hormone levels in the anterior pituitary would
also be low. The hypothalamus releases TRH, which stimulates TSH production. If TRH was
injected into the hypothalamus from a tumor, then high levels of both TSH & Thyroid Hormones
would be seen.
 Conclusion
Treatment recommendations:
Levothyroxine - T4 thyroid hormone replacement
medicine
Radioactive Iodine
Surgical tumor removal
 Conclusion
The results of the blood sample reveal that the patients TSH and thyroid
hormone levels are low. An MRI scan also confirms that the the hormone
suppressing tumor is located on her anterior pituitary. The doctor decides to
treat her condition by using thyroid hormone therapy.