Essay Sample: Dialogue Between a Doctor and a Patient Suspected to Suffer from Grave's Disease

(Setting: The bedside of the patient in the Intensive Care Unit (ICU), the doctor approaches the patient)

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Doctor: Good afternoon Mrs. DJ, My name is Doctor BT, I am your attending physician. How are you feeling now?

Patient: I feel much better. It is not as bad as when I came in. Doctor BT could you kindly explain to me what is wrong with me?

Doctor: We are suspecting that have hyperthyroidism caused by Grave's disease. Hyperthyroidism is a state where the thyroid gland is overworking and producing too many hormones. The hormones are called triiodothyronine (T3) and tetraiodothyronine (T4). These hormones are responsible for most of the signs you presented with.

Doctor: Are we together up to this point?

Patient: Yes doctor, we are.

Doctor: T4 and T3 are hormones which when they bind to their receptors found almost everywhere in the body cause various effects when in excess. In the heart, the hormones cause increased heart rate, and in the bowels, they cause loose motions. Also, when in excess they cause fever and weight loss.

Patient: Yes doctor those are the symptoms I had.

Doctor: The excess hormones were responsible for the symptoms. It is dangerous when hormones soar to very high levels because we can get a thyroid storm. Therefore, the body always puts mechanisms in place to ensure the hormones are within the normal physiological levels.

Patient: What is thyroid storm?

Doctor: Thyroid storm is a life-threatening condition that occurs when thyroid hormones are very high. It causes elevated heart rate, blood pressure, and temperature. It is also called thyrotoxicosis crisis. Hope you understand me?

Patient: Oh yes I am.

Doctor: However, for us to conclusively say that you have hyperthyroidism additional tests have to be conducted. We will do a thyroid profile- this will show us the number of hormones in your blood. If they are increased, it implies that the thyroid is overworking. In the thyroid profile test, we will also look for another parameter called Thyroid Stimulating Hormone (TSH). It is a hormone that is produced in the brain, and it helps the thyroid to function. Depending on whether it is increased or decreased, we will be in a position to know the next test to carry out. We will either do brain imaging or immunology tests. The latter include Thyroid-stimulating Immunoglobulin (TSI) and Thyroid Peroxidase Antibodies (TPO) Levels. Also, we will also do an ultrasound of the thyroid gland. All these tests will enable us to come up with a definitive diagnosis.

Patient: My mother and sister have the same problem too doctor.

Doctor: I am sorry for that. That is the reason why we are suspecting Grave's disease. There is a high likelihood that you and your sister inherited the genes from your mother. It is an autoimmune disease- where the body attacks itself and is commoner in women.

Patient: Thanks, doctor, now I understand. They took blood from me and said they are going to run some tests, are the results out?

Doctor: Yes the results are out. The blood workups show that you have an infection- most likely a viral one. However, we are doing a blood culture to rule out a bacterial cause. We have also done thyroid function tests. The results show that you have increased T4 and TSH.

Patient: But doctor I don't understand. What normally happens in the thyroid system?

Doctor: It's quite simple. There are three organs involved and three hormones. The organs are the hypothalamus, the pituitary gland and the thyroid gland itself.

Patient: Where are those organs?

Doctor: The hypothalamus and the pituitary gland are in your brain. They are part of the midbrain and are connected through the hypothalamo-pituitary system.

Patient: So what exactly happens?

Doctor: The hypothalamus produces a hormone called Thyroid Releasing Hormone. This is just a chemical compound. The compound goes to the anterior part of the pituitary gland and stimulates the release of another hormone. Are we together so far?

Patient: Yes we are

Doctor: In the anterior pituitary another hormone is released. This is called the Thyroid Stimulating Hormone which in term goes to the thyroid gland and stimulates it? The thyroid then produces the thyroid hormones called triiodothyronine and thyroxine.

Patient: Wow, those are difficult names

Doctor: You can just refer triiodothyronine as T3 and thyroxine as T4

Patient: That's better.

Doctor: These two hormone hormones have receptors in many cells in the body.

Patient: Doctor, so what might have caused my problem?

Doctor: For your case, luckily the problem is not in the brain it's in the thyroid gland itself. Your thyroid is producing excessive T4 despite normal levels of Thyroid Stimulating Hormone from the pituitary gland. This is called secondary hyperthyroidism, and it has many causes. These include thyroiditis, multi-nodular goiter, Graves' disease and a single hyperfunctioning hot nodule.

Patient: What are those?

Doctor: Thyroiditis is an inflammation of the thyroid gland. Multinodular goiter is an enlarged thyroid that has many nodules. Multi-nodular goiters can either be toxic (making too much thyroid hormone) or non-toxic (doesn't make too much thyroid hormone). What causes multi-nodular goiter is unknown.

Patient: What about the rest?

Doctor: Graves' disease is an auto-immune condition that causes an overproduction of thyroid hormones. The body forms antibodies called thyroid stimulating immunoglobulins (TSI) that stimulate the thyroid gland to produce thyroid hormone in excess. For the last one, a hot nodule is a nodule that picks up radioactive iodine during a thyroid scan. It is normally a benign hyperactive nodule that produces excessive thyroid hormones.

Patient: Doctor, of all the causes you have listed, which particular one caused my problemDoctor: From the results, we have gotten from the lab, you seem to have Graves' disease.

Patient: Am I going to die?

Doctor: No. You will be fine. Graves' disease has numerous treatment options.

Patient: Like which ones?

Doctor: Radioactive iodine therapy is one option.

Patient: How does that one work?

Doctor: You take radioactive iodine which is taken up by the thyroid and destroys overactive thyroid cells. The other option is using anti-thyroid medication.

Patient: Kindly explain?

Doctor: These are drugs that interfere with the thyroid's use of iodine to produce hormones. Some of the drugs include methimazole and propylthiouracil.

Patient: Are there any other drug options?

Doctor: Yes, there is a class of drugs called Beta Blockers that are useful in managing Graves ' disease. These drugs inhibit the action of the thyroid hormones on the receptors. So despite high hormonal levels, the effect is still within normal range.

Patient: Is there a cure?

Doctor: Total surgical resection of the gland is a curative option, but you will have to be on life-long hormonal therapy to replace the thyroid hormones and parathyroid hormones which may be affected.