A 55-year-old female presents with epigastric pain that radiates to her back. She has no medical history and does not take any regular medications. Her alcohol consumption is limited to 3 glasses of wine per week. Blood tests reveal elevated triglyceride levels and a high CRP level. An abdominal ultrasound shows no gallstones or duct dilation. What measures can be taken to prevent the recurrence of pancreatitis?
You assess a 29-year-old woman who is 24 weeks pregnant. Due to her BMI of 33 kg/m², she underwent a routine oral glucose tolerance test which yielded the following results:
Time (hours) Blood glucose (mmol/l)
0 7.8
2 10.6
Apart from this, there have been no other complications during her pregnancy and her anomaly scan showed no abnormalities. What would be the best course of action?
A 72 year old man was admitted to hospital with symptoms of shortness of breath, productive cough and palpitations. Upon examination, a chest x-ray revealed a left lower lobe pneumonia and an ECG showed atrial fibrillation with a fast ventricular response. The patient was treated with intravenous antibiotics, fluids and oral digoxin loading, which resulted in significant improvement in his condition. During a follow-up examination, a repeat ECG showed that the patient had cardioverted back to sinus rhythm and digoxin therapy was discontinued. Thyroid function tests were ordered to investigate the underlying cause of atrial fibrillation, with the following results:
– Haemoglobin: 130 g/dL
– White cell count: 12.5* 109/L
– Neutrophils: 10.8* 109/L
– Platelets: 320* 109/L
– Urea: 4.2 mmol/L
– Creatinine: 120 micromol/L
– Sodium: 140 mmol/L
– Potassium: 3.8 mmol/L
– C-reactive protein: 95 mg/L
– Thyroid stimulating hormone: 0.3 microU/L
– T4 free serum: 13.8 pmol/L
– T3 free serum: 6.9 pmol/L
What is the most appropriate next investigation to assess the patient’s deranged thyroid function tests?
What are the thyroid function testing (TFT) findings that are characteristic of sick euthyroid syndrome?
A 16-year-old boy comes to the endocrine clinic for evaluation. He has been experiencing excessive urination for as long as he can remember and has been prescribed indomethacin by his GP to reduce his urine output. He mentions that his older sister also has a similar condition, but only during pregnancy. During the examination, his BP is 122/82, with a postural drop of 15 mmHg, and his pulse is 80 and regular.
Investigations reveal:
– Hb 145 g/l (135-180)
– WCC 5.1×10(9)/l (3.8-10.8)
– PLT 221×10(9)/l (150-450)
– Na 147 mmol/l (135-145)
– K 5.1 mmol/l (3.5-5.5)
– Bicarbonate 27 mmol/l (18-28)
– Cr 125 micromol/l (60-110)
– Glucose 5.1 mmol/l (<7)
Which of the following additional interventions is most likely to benefit him?
A 54-year-old woman presents to the hospital with a three-day history of malaise, myalgia, fever, and neck pain. She had a recent upper respiratory tract infection that resolved on its own. On examination, she appears unwell with an enlarged and tender thyroid gland. Her blood work shows elevated T4 and T3 levels and a suppressed TSH level. Which investigation would be most useful in determining her diagnosis?
A 32-year-old man visits his primary care physician (PCP) complaining of feeling unwell and experiencing pain in his neck for the past two weeks. He describes his symptoms as similar to a severe flu-like illness.
During the examination, his pulse is found to be 110 beats per minute (bpm) and regular, while his blood pressure (BP) is 126/72 mmHg. He has a slight tremor and his palms are sweaty. His thyroid is slightly enlarged, smooth, and tender to the touch.
Further investigations reveal the following results:
Thyroxine (T4) 38 nmol/l 11–22 pmol/l
Thyroid Stimulating Hormone (TSH) <0.01 µU/l 0.17–3.2 µU/l
Erythrocyte Sedimentation Rate (ESR) 35 mm/hour 1–20 mm/hour
What is the most likely diagnosis for this patient?
A 65-year-old woman presents to her General Practitioner with mild lethargy. A thyroid function test is requested and unexpectedly demonstrates a suppressed Thyroid Stimulating Hormone level (0.25 microU / L) but normal free T4 level (14.1 pmol / L). The patient denies any heat intolerance, weight loss, diarrhoea, hair or skin changes, palpitations or eye symptoms. What is the most appropriate management for the deranged thyroid function tests?
A 63-year-old female presents with mild confusion. She has a medical history of depression, type 2 diabetes mellitus, and angina, and takes multiple medications. Upon investigation, her sodium concentration is 123 mmol/L (137-144), potassium is 3.4 mmol/L (3.5-4.9), urea is 5.2 mmol/L (2.5-7.5), and creatinine is 70 µmol/L (60-110). Her plasma osmolality is 260 mosmol/L, urine osmolality is 650 mosmol/L, and urine sodium concentration is 38 mmol/L. What medication or agent could be responsible for her symptoms?
A 35-year-old female presents to the medical outpatient department with a progressive loss of libido. She attributes this to persistent diarrhoea, which she has noted over the last 6 months. She has also lost 14kg of weight and feels fatigued. She has noticed that her eyes have become grossly protuberant and she has double vision on looking towards either the right or left. She also experiences painful watering of her eyes.
On examination she has a marked tremor in both hands, her heart rate is irregularly irregular and she has marked exophthalmos. There is an audible bruit on auscultation of the thyroid gland.
Her laboratory investigations reveal:
Hb 130 g/l
MCV 77 fl
MCH 29 pg
WBC 7.4 * 109/l
Plt 430 * 109/l
TSH 0.03 mU/l (0.4 3.6 mU/l)
Total T4 302 nmol/l (68 174 nmol/l)
CT scan of the orbits reveals taut optic nerves and retro-orbital oedema.
What is the most appropriate management for her eye condition?