Case 9 quiz

What are the symptoms of a thyroid storm?

• tachycardia, pyrexia, confusion

• tachycardia, hypertension, constipation

• bradycardia, hypothermia, muscle spasms

• bradycardia, hypotension, vomiting

Answer explanation

not 2 because causes diarrhoea

not 3 or 4 because causes tachycardia

Which TR can T3 not bind to

• alpha-1

• alpha-2

• beta-1

• beta-2

Answer explanation

All TR have a higher affinity for T3, except apha-2 which can only bind to T4. T4/T3 bind to TR homodimers or heterodimers to cross the cell surface membrane.

which is NOT treated with thyroid hormones?

• hypothyroidism

• Hashimoto's thyroiditis

• hyperthyroidism

• diffuse non-toxic goitre

Answer explanation

Thyroid hormones are used to treat hypothyroidism (primary and secondary), when there are low levels of T4 and T3. You can be given levothyroxine sodium or liothyronine sodium. Hashimoto's is an autoimmune disease when the immune system targets the thyroid gland, there is a build up of WBC in the thyroid and it does not produce adequate t4/T3. Diffuse non-toxic goitre is actually just an enlarged thyroid gland with no abnormlal thyroid function, it can be treated with T4 or iodine to reduce its size (I'm not sure why it works exactly).

How long do symptoms have to be present for a diagnosis of depression?

• 1 week

• 2 weeks

• 6 months

• 1 year

Answer explanation

Depression is diagnosed when symptoms are present for 2 weeks. Mania can be diagnosed when symptoms are for 1 week (4 days for hypomania). Anxiety is diagnosed after 6 months (GAD). 1 year was just a random time-frame.

A patient has been diagnosed with MDE and has increased appetite, hypersomnia and leaden paralysis, what is the specifier?

• Melancholic

• Atypical

• Seasonal

• Psychotic

Answer explanation

It is atypical - these are symptoms of atypical depression as it is more rare to see these (compared to weight/appetite loss and insomnia). Melancholic depression involves feelings of immense sadness (melancholy), seasonal depression is when depression is at certain times of year (usually winter), psychotic depression has associated psychotic symptoms (delusion, hallucinations and thought disorder).

Which is not a hormone secreted by the thyroid gland?

• Calcitonin

• T3

• T4

• Thyroglobulin

Answer explanation

Calcitonin is released by the parathyroid glands and it is involved in calcium homeostasis (it reduces release of calcium from bones and decreases reabsorption at proximal tubule), thyroglobulin is a glycoprotein NOT a hormone.