A 43-year-old woman complains of muscle cramps and fatigue. Upon examination, her neck’s front is tender and swollen to touch. She has no medical history and does not take any regular medication. Her blood results show a TSH level of 12.3 mU/L (0.5-5.5) and a free T4 level of 4.2 pmol/L (9.0 – 18). What is the probable diagnosis?
A 32-year-old woman presents to the endocrine clinic with thyroid function test results indicating palpitations, excessive sweating, unintentional weight loss, and a notable thyroid goitre that is tender upon palpation. The test results show a TSH level of 9.4 mU/L (normal range: 0.5-5.5) and a free T4 level of 6.4 pmol/L (normal range: 9.0-18). What is the probable diagnosis?
A 52-year-old man has been diagnosed with type two diabetes and prescribed medication by his GP. The medication functions by binding to its receptor and closing the potassium ion channels, which reduces potassium efflux from the cell and causes depolarization. This, in turn, leads to calcium ion influx and insulin release. What medication has the patient been prescribed?
A 70-year-old man is admitted to the acute medical unit with an infective exacerbation of chronic obstructive pulmonary disease (COPD) which has failed to improve despite a course of antibiotics and steroids. He has a medical history of type 2 diabetes and hypertension and takes aspirin, simvastatin, amlodipine, and metformin. His random blood glucose on admission is 12.3mmol/l and a HbA1c test is ordered, which shows an IFCC-HbA1c of 45 mmol/mol and HbA1c of 6.3%. What is the best course of action?
A 65-year-old woman comes in for a check-up with her doctor. She has a history of hypothyroidism and is currently taking 100mcg of levothyroxine. She reports feeling well and has no notable symptoms. Her last TFTs were normal 6 months ago.
Free T4 18.5 pmol/l
TSH 0.1 mu/l
What should be done next?
A 42-year-old woman presents to her GP with complaints of ongoing fatigue and tiredness. She has a medical history of hypertension and eczema, and no significant family history. Upon conducting a blood test, the following results were obtained:
– Hb: 141 g/l
– Platelets: 222 * 109/l
– WBC: 6.3 * 109/l
– Neuts: 3.9 * 109/l
– Lymphs: 1.2 * 109/l
– Na+: 140 mmol/l
– K+: 4.1 mmol/l
– Urea: 4.9 mmol/l
– Creatinine: 83 µmol/l
– CRP: 4.1 mg/l
– TSH: 6.2 mu/l
– Free T4: 6 pmol/l
What is the most likely pathology causing her symptoms?
A 25-year-old man presents to the emergency department with abdominal pain and lethargy. He has areas of skin hyperpigmentation and hypopigmentation consistent with vitiligo. His blood pressure is 96/58 mmHg. Laboratory tests reveal the following results, and treatment is initiated.
Hemoglobin: 138 g/L (Male: 135-180, Female: 115-160)
Platelets: 210 * 109/L (150-400)
White blood cells: 11.5 * 109/L (4.0-11.0)
Sodium: 133 mmol/L (135-145)
Potassium: 5.8 mmol/L (3.5-5.0)
Urea: 6.5 mmol/L (2.0-7.0)
Creatinine: 95 µmol/L (55-120)
C-reactive protein: 4 mg/L (<5)
Fasting blood sugar: 4.4 mmol/L (4-7)
What is the most appropriate diagnostic test for the likely diagnosis?
A 49-year-old woman is admitted to the surgical ward with severe loin to groin abdominal pain. A CT-KUB reveals a right-sided renal calculus. When you take her medical history, she confesses that she has been feeling unwell for the past few weeks with symptoms of polyuria, polydipsia, constipation and altered mood.
Her blood tests show an estimated glomerular filtration rate of >60 ml/min, adjusted calcium of 3.1 mmol/l (2.1-2.6 mmol/l), phosphate of 0.6 mmol/l (0.8-1.4 mol/l), and parathyroid hormone of 5.1 pmol/l (1.2-5.8 pmol/l).
What is the most probable cause of her symptoms?
A 35-year-old man with type 1 diabetes visits his GP for a check-up on his blood sugar levels. He has been monitoring his daily blood glucose readings and the GP calculates an average of 7.8 mmol/L, indicating the need for better control. However, his HbA1c level is 41.5 mmol/mol (5.9%), indicating good glycaemic control. What could be causing this inconsistency?
During a geriatrics ward round, you assess a 87-year-old woman who was admitted with community acquired pneumonia and AKI requiring IV antibiotics and fluids. She was delirious on admission but has been improving. Her confusion screen bloods show abnormal thyroid function tests:
Calcium 2.2 mmol/L (2.1 – 2.6)
Phosphate 1.0 mmol/L (0.8 – 1.4)
Magnesium 0.8 mmol/L (0.7 – 1.0)
Vitamin B12 550 pg/ml (110 – 1500)
Folate 5.6 µg/ml (2.5 – 20)
TSH 4.6 mU/L (0.5 – 5.5)
Free T4 6.0 pmol/L (9.0 – 18)
Free T3 3.6 pmol/L (4 – 7.4)
She is currently feeling much better on day 6 of her 7 day course of antibiotics and is asymptomatic. She takes bisoprolol, digoxin, ramipril, atorvastatin, and rivaroxaban regularly.
What is the appropriate course of action for her abnormal thyroid function tests?