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Endocrinology: weight loss

Elizabeth Jones is a 23 year old first year medical student. This morning she had a lecture on endocrinology disorders and is now feeling a little concerned. Lately she has been experiencing a massive increase in appetite, significant weight loss (now that she thinks about it), she’s still wearing shorts even though it’s November and when she sits still her arms shake a bit. The more she thinks about it the more convinced she gets and so she decides to make an appointment to see her GP the next day.

The next day she speaks to her GP who takes a long history and performs a thorough examination. Which of the following clinical signs might the GP elicit if Elizabeth has hyperthyroidism?

Given that hyperthyroidism runs in Elizabeth’s family and she has type I diabetes the GP agrees that it would be a good idea to run a few blood tests. Which of the following test results is most likely to indicate the presence of hyperthyroidism?

Why does Elizabeth’s GP also perform a FBC?

Which antibodies may be raised in autoimmune hyperthyroidism?

The results return and Elizabeth does indeed have hyperthyroidism, most likely Grave’s disease. Which 3 signs of hyperthyroidism are predominantly associated with Grave’s disease?

  • Toxic adenoma
  • Amiodarone
  • Ectopic thyroid tissue
  • Primary atrophic hypothyroidism
  • Subacute de Quervain’s thyroiditis
  • Exogenous iodine
  • Post-thyroidectomy
  • Grave’s disease
  • Hashimoto’s thyroiditis
  • Lithium
  • Subacute de Quervain’s thyroiditis
  • Amiodarone
  • Post-radioiodine
  • Toxic multinodular goitre
  • Lithium

The GP discusses the possible treatment options with Elizabeth, and together they agree to try medical treatment first. Which of the following drugs might be prescribed for Elizabeth?

Which of the following side effects are known to be potentially associated with the use of carbimazole?

Unfortunately 12 months later Elizabeth is still having trouble keeping her thyroid hormone levels in check. What other treatment options are likely to be offered next?

If Elizabeth were to opt for a thyroidectomy, damage to which nerve (leading to a hoarse voice) will be mentioned amongst the potential risks of surgery?

 
Elizabeth elects to go for surgery and her hyperthyroidism is cured. However she subsequently develops hypothyroidism and requires levothyroxine to be asymptomatic. Over a few months her GP manages to correctly adjust her doseage by monitoring her TSH and she manages to successfully graduate medical school.
 
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Hyperthryoidism symptoms

Signs and symptoms of hyperthyroidism. © 2007 Nursing Education Consultant, Inc.



















Graves disease eyes

Proptosis in hyperthryoidism. © The Eyes Have It.

Pretibial myxodema

Pretibial myxoedema. © Herbert L. Fred, MD and Hendrik A. van Dijk.







Goitre

Goitre. © Drahreg01.
































Thyroidectomy.