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Hot and Bothered

A Case of Endocrine Disease


Karin Grimnes


This interrupted case study is a story about Carrie and her infant daughter Hayden who share similar symptoms: weight loss, metabolic abnormalities, and endocrine glands that just won't quit - as well as autoimmune complications. Students will eventually determine that Graves disease is the underlying condition; however, the point of the story is less about the diagnosis and more about understanding the complex interplay of receptor, ligand, and feedback loops as well as how this interplay is complicated by receptor-based autoimmunity. Students interpret some simplified lab results and tie them to their physiological consequences. They also gain a deeper understanding of how maternally produced antibodies can cause problems for a child before and/or after birth. Although designed for an upper division immunology class, this case also could be used in a human physiology or pathophysiology classroom.

  • Compose a simple hormone feedback loop between the pituitary and the thyroid glands and understand how it functions to maintain homeostasis.
  • Determine how an autoimmune disease against cell surface receptors (such as Grave’s disease) can interfere with feedback loops to cause pathology.
  • Gain more experience interpreting data and linking test results to physiological consequences.
  • Understand how maternally produced antibodies (usually considered a benefit) can cause problems for a child before and/or after birth.
Keywords: Immunology; pituitary; thyroid; autoimmunity; antibody; receptor; pathophysiology; hypersensitivity; Grave’s disease; Graves disease
Topical Area: N/A
Educational Level: Undergraduate lower division, Undergraduate upper division
Formats: PDF
Type/Method: Directed, Interrupted
Language: English
Subject Headings: Biology (General)   Physiology   Medicine (General)   Microbiology  
Date Posted: 9/19/2011
Date Modified:
Copyright: Copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

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Hi there, Regarding this question 4. If Carrie had continued to breast feed, how would that have affected Hayden’s problem? Do the TSHR-Ab's make it into breast milk and if they do, are they actually adsorbed from the GI tract - is that how they worsen the condition in the baby? More antibodies would have entered Hayden and made her thyroid problem even worse.

Thanks so much, Donnell

Donnell Wolff
Medical Laboratory Technology
Southern Alberta Institute of Technology
Calgary, Alberta, Canada, T2M 0L4

Author's Response to Donnell Wolff's Comment

The major antibody found in breast milk is the IgA secreted from the breast tissue. There is evidence for IgG and IgM antibodies present in breast milk as well. These additional antibodies can be taken up by the baby through the digestive system and contribute to immunological defense in a minor way. I have not found specific evidence that the IgG antibodies in Grave's disease behave differently from other antibodies, hence this minor contribution is the foundation for question #4. Discussing the relative magnitude of the placental vs. breast milk contribution to Hayden's problem could be an extension of the question. I did not address this in the case.

Kay Grimnes
Professor of Biology
Alma College
Alma, Michigan 48801

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