A 30-year-old woman with hyperthyroidism is diagnosed with Graves’ disease and prescribed carbimazole for treatment. During counselling, she is informed about the potential side-effects of the medication.
What is the most severe adverse reaction of carbimazole?
A 40-year-old woman has poorly controlled type II diabetes mellitus. She is unable to tolerate metformin and so takes sitagliptin. Given her poor control, pioglitazone is added. She has read some information online about pioglitazone and would like some more information.
What is the best advice you can provide her about the potential effects of pioglitazone use?
A 50-year-old woman has been diagnosed with hypothyroidism and iron-deficiency anaemia after complaining of feeling very tired. She was started on levothyroxine and ferrous sulphate and has been taking these for the last six months. Three months ago her blood tests showed:
Haemoglobin 120 g/L (115-160 g/L)
Ferritin 60 ng/mL (20-230 ng/ml)
Thyroid Stimulating Hormone (TSH) 6.9 mu/L (0.5-5.5 mu/L)
She was continued on levothyroxine and ferrous sulphate tablets for a further 3 months. Her blood tests were repeated today which show:
Haemoglobin 130 g/L (115-160 g/L)
Ferritin 110 ng/mL (20-230 ng/ml)
TSH 7 mu/L (0.5-5.5 mu/L)
What is the next appropriate step in managing this patient?
A 12-year-old boy attends his General Practitioner, concerned that he is not developing normally. He is one of the shortest boys in his year group, and feels that his genitals are not the same as others in his year group. He is concerned that his voice has not ‘dropped’ and that he doesn’t have pubic or axillary hair.
On examination, he has no pubic, axillary, or facial hair. He has bilaterally descended testes, with a volume of 3 ml each. His father said he was himself a ‘late developer’.
What is the most likely diagnosis?
A 25 year old woman visits a fertility clinic with her partner due to oligomenorrhoea and galactorrhea. Despite having regular unprotected intercourse for 18 months, she has been unable to conceive. Upon conducting blood tests, it is discovered that her serum prolactin level is 6000 mIU/l (normal <500 mIU/l). Further investigation through a pituitary MRI reveals a microprolactinoma. What initial treatment options are likely to be presented to her?
A 55-year-old man who is a type II diabetic presents to his General Practitioner with concerns about persistent premature ejaculation. He also reports occasional erectile dysfunction. The only medication he takes is metformin. His recent glycosylated haemoglobin (HbA1c) result is 72 mmol/l (normal: 48 mmol/l).
What is the most appropriate medication alteration required to improve this man’s symptoms?
A 50-year-old woman schedules a routine appointment to discuss her menopausal symptoms. She has been experiencing hot flashes, mood swings, and insomnia for the past year. Her friend recently started hormone replacement therapy (HRT) for similar symptoms and found it to be very helpful. The patient is interested in trying HRT and has already read about the potential risks of breast and ovarian cancer on the NHS website. She has no medical history and is not taking any medications, but she does mention that her sister has had multiple blood clots and is currently taking blood thinners.
What is the most appropriate course of action?
One of your elderly patients has been diagnosed with metabolic syndrome. What is one of the associations with this condition?
A 25-year-old female patient complains of tremors and excessive sweating. Upon conducting thyroid function tests, the results are as follows:
TSH <0.05 mU/l
Free T4 25 pmol/l
What is the leading cause of this clinical presentation?
A 29-year-old woman had presented with occasional palpitations, sweating and restlessness. An ECG had shown sinus tachycardia.
Her blood tests had showed:
Thyroid stimulating hormone (TSH) 0.2 mU/L (0.5-5.5)
Free thyroxine (T4) 23 pmol/L (9.0 – 18)
You had started her on a beta-blocker and referred her to secondary care for specialist treatment. However, the patient returns to you stating that her appointment is in 4 months’ time and she cannot carry on with her symptoms for that long.
What is the most appropriate course of action?