The Case of the Sweaty Salesman Michael

The Case of the Sweaty Salesman Michael

This week’s topic is: The Case of the Sweaty Salesman Michael is a thirty-year-old salesman who spends approximately 4 days each week traveling to visit with customers in his region. During his routine physical he casually mentions to his physician that he seems to be sweating more profusely than normal and most rooms that once were comfortable are now too \”hot\”. He thought that it was simply due to the change in seasons and companies being slow to turn down the thermostats from the winter temperatures, however, this problem seems to persist even when he is at home. A room that his wife and children find to be comfortable causes him to sweat profusely. Michael also reports that he seems to be losing weight even though his appetite has increased. He also complains that he has a shortened attention span and that he always wants to be moving around. Despite the fact that he feels fatigued, Michael claims to have difficulty sleeping and seems to have more frequent bowel movements, occasionally accompanied by diarrhea. The physician checks Michael\’s medical history and finds that indeed he has lost 15 pounds since his last physical. Wanting to rule out the possibility of infection with the human immunodeficiency virus (HIV), the physician asks Michael questions about his sexual history and practices and finds that he is not at risk for HIV infection. Also in checking his chart, the physician finds that Michael has a negative history for chronic illnesses, does not smoke, and has a low risk for cardiovascular disease. He does, however, have a positive family history for autoimmune diseases. His father suffers from idiopathic thrombocytopenia, his mother has been diagnosed with rheumatoid arthritis and his oldest sister was recently diagnosed with systemic lupus erythematosus. Results of Michael\’s physical examination were within normal ranges with the exception of the following: he demonstrated tachycardia, loud heart sounds, and apparent cardiac arrhythmia accompanied by slight hypertension. The arrhythmia was confirmed by the electrocardiogram to be supra-ventricular in origin. Michael\’s eyeballs appeared large and protruding and his hair was fine and soft. He was also beginning to demonstrate some degree of alopecia. Michael was also observed to have palmar erythema. Palpation of the neck revealed the presence of goiter. Results of blood tests indicated elevated concentrations of thyroid hormones (thyroxin and triiodothyronine),hypercalcemia, and decreased circulating concentrations of lipids. Based on the physical characteristics and the results of the blood tests, Michael\’s physician suspected that Michael was suffering from some form of hyperthyroidism and sent him to an endocrinologist to confirm the initial diagnosis Case of the Sweaty Salesman. Following the initial consultation and examination, the endocrinologist ordered tests to determine whether Michael was indeed hyperthyroid. The test results indicated an elevation in the concentration of thyroid hormones in the blood and the presence of thyroid-stimulating antibodies. These antibodies specifically stimulate the thyroid gland by binding with the thyroid-stimulating hormone receptor located on the plasma membrane of the follicular cells of the thyroid gland. Based on these results, the endocrinologist concluded that Michael had Grave\’s disease, a form of hyperthyroidism believed to be autoimmune in nature. Michael was presented with a number of possible treatment options. These included treatment with chemicals (propylthiouracil and methimazole) that decrease the production of thyroid hormones by the thyroid gland, radio-isotopic destruction of the thyroid gland by the use of 131I, and surgical removal of the thyroid gland. After considering all the options, especially the possible effects of radiation on gamete development, Michael chose surgery.  Following successful surgery, Michael was prescribed synthetic thyroid hormone to ensure that his body was receiving adequate thyroid hormone and told to return within 2 months for a follow-up evaluation of circulating thyroid hormone concentrations. He was also cautioned to carefully monitor his calcium intake. Using the the terms covered this week answer the following questions about this case: Why would an imbalance in thyroid hormones have such a widespread effect on the body? Why was goiter observed in Michael’s case? Given that Michael and his wife may want to have more children, why was radio-isotopic, for the destruction of the thyroid gland, ruled out? Case of the Sweaty Salesman.

The Story of the Sweaty Sales Representative

This Week’s Focus: The Story of the Sweaty Sales Representative

Michael, a thirty-year-old salesman, spends around 4 days each week traveling for work to meet customers in his region. During his regular checkup, he mentions to his doctor that he’s been sweating more than usual, feeling too warm in rooms he used to find comfortable. He thought it might be due to the changing seasons and slow thermostat adjustments after winter, but this issue persists even at home. Rooms that feel fine to his family make him sweat a lot. Michael notices weight loss despite increased appetite, shorter attention span, and restlessness. Although he’s tired, he struggles to sleep and experiences more bowel movements with occasional diarrhea.

His medical history shows a 15-pound weight loss since the last checkup. The doctor checks for HIV risk, considering symptoms, but Michael isn’t at risk. Michael’s family history has autoimmune diseases, with his father having idiopathic thrombocytopenia, his mother rheumatoid arthritis, and his sister systemic lupus erythematosus. Michael’s physical exam shows tachycardia, loud heart sounds, and cardiac arrhythmia with slight high blood pressure. His eyes are large and bulging, hair thin and soft, and he’s experiencing some hair loss. Palms are red, and his neck has a goiter. Blood tests reveal high thyroid hormone levels, high calcium, and low lipid levels. Based on these findings, the doctor suspects hyperthyroidism and sends Michael to an endocrinologist for confirmation.

The endocrinologist performs tests indicating high thyroid hormone levels and thyroid-stimulating antibodies. These antibodies stimulate the thyroid gland by binding with thyroid-stimulating hormone receptors on thyroid follicular cells’ membranes. This leads to the diagnosis of Grave’s disease, an autoimmune form of hyperthyroidism. Treatment options are discussed, including drugs (propylthiouracil and methimazole) to reduce thyroid hormone production, using radioactive iodine (131I) to destroy the thyroid, or surgical removal. Michael chooses surgery considering potential effects of radiation on reproduction.

After successful surgery, Michael takes synthetic thyroid hormone for balance and is advised to return in 2 months for follow-up on hormone levels. He’s also cautioned to watch his calcium intake. Using this week’s terms, let’s address questions about this case.

Why would an imbalance in thyroid hormones affect the body so widely?

Thyroid hormones control metabolism, affecting energy, temperature regulation, and more. An imbalance disrupts these processes, causing symptoms throughout the body.

Why was goiter observed in Michael’s case?

Goiter, an enlarged thyroid, can result from hyperthyroidism as the body attempts to produce more thyroid hormones.

Why was radio-isotopic destruction of the thyroid ruled out for Michael, considering his desire for more children?

Radioactive iodine could affect gamete development, possibly impacting future children’s health.