65-year-old man was diagnosed with AF and commenced on amiodarone two years ago.His thyroid function tests prior to commencing amiodarone were normal. He subsequently developed hyperthyroidism whilst on amiodarone.

Amiodarone was stopped four months ago and he was commenced on 40 mg carbimazole OD but he continued to lose weight despite maintaining a good appetite.

His RX digoxin 250 micrograms OD and warfarin as per INR. On examination, pulse was 92 BPM, irregularly irregular, BP 130/70 mmHg. There was no goitre.

Serum creatinine 88 µmol/L

Plasma free T4 56 pmol/L

plasma free T3 14.2 pmol/L

Plasma TSH <0.02 mU/L

Serum antithyroid peroxidase 12 U/mL

TSH receptor antibodies <1 U/L (<7)

RAI UPTAKE<1 %

WHAT IS THE MOST LIKELY DIAGNOSIS

25-year-old pregnant lady attends follow-up clinic at the endocrine antenatal clinic. She is 20 weeks pregnant and currently taking PTU 50 mg for Grave's disease. She feels well in herself.

Her thyroid hormone profile shows:

next most appropriate step in managent

FT4 19 TSH 1.5

45 year-old woman presented with a six week history of 7 kg weight loss and heat intolerance.

Which of the following features would support a diagnosis of Graves' disease?

T4- 45 TSH 0.005

65-year-old man was diagnosed with AF and commenced on amiodarone two years ago.TFT prior to commencing amiodarone were normal. He developed hyperthyroidism whilst on amiodarone.

Amiodarone was stopped four months ago and he was commenced on 40 mg carbimazole OD but he continued to lose weight despite maintaining a good appetite.

His RX digoxin 250 micrograms OD and warfarin as per INR. On examination, pulse was 92 BPM, irregularly irregular, BP 130/70 mmHg. There was no goitre.

WHAT IS THE MOST LIKELY DIAGNOSIS

Serum creatinine 88 µmol/L

Plasma free T4 56 pmol/L

Plasma free T3 14.2 pmol/L

Plasma TSH <0.02 mU/L

Serum antithyroid peroxidase 12 U/mL

TSH receptor antibodies <1 U/L

RAI UPTAKE < 1 %

68-year-old woman with hypothyroidism due to Hashimoto's thyroiditis comes to the clinic for review. Last year she has developed epilepsy and has been diagnosed with osteoporosis having sustained a left Colles' fracture. She complains of increasing tiredness and weight gain over the past 6 months.

Her TSH, previously stable in the middle of the normal range on 100 mcg of thyroxine per day, has risen to 6.5 mIU/L (0.5-4.5).

Which of the following is the most likely cause?

52-year-old woman with a IHD is admitted to the ICU with acute LVF. She has been deteriorating with increasingly severe tachycardia and shortness of breath over the past two weeks, and has lost 5 kg in weight. Medication of note includes ramipril, furosemide, atorvastatin and aspirin.

Her blood pressure is 132/80 mmHg, pulse is 130 bpm, atrial fibrillation (AF). There are bilateral crackles to the mid-zones on auscultation of the chest, and bilateral pitting oedema of both ankles. TSH <0.05 mU/L.

Bisoprolol and carbimazole started

Which other intervention is likely to be of most value in stabilising this patient?

69-male c/o tiredness and neck tenderness. Six months ago he was admitted with angina associated with AF which settled following intravenous digoxin.

Since then treated with amiodarone 200 OD. He also takes aspirin 75 mg OD and atenolol 50 mg daily together with pravastatin 40 mg daily. Recent 24 hour ECG shows sinus rhythm throughout with occasional ventricular ectopics.

O/E fine tremor, and a pulse of 56 beats per minute with a blood pressure of 146/88 mmHg. No goitre but mild tenderness in the thyroid area.

I FT4 33.1 TSH <0.02

What is the best management strategy for this patient?

52-year-old female presents with tiredness.

There are no specific abnormalities noted on examination, but investigations reveal:

t4 21 T3 5.2 TSH 0.05

What most common diagnosis do these results suggest?

Which of the following is a glycoprotein hormone?

28-year-old female presents in the 24th week of pregnancy with profound tiredness and anxiety. Examination reveals a tremor, a pulse of 100 beats per minute and a soft bruit heard over the thyroid gland.

TSH 0.04 T4 34

Which of the following treatments would you select for this patient?

64-year-old lady presented to the Emergency department with orbital pain and swelling (shown below):She had been under review in the endocrinology clinic and had been started on some new treatment four weeks previously.

TSH 28 WAS 0.01 LAST VISIT T4 2 WAS 98 LAST VISIT

WHAT TREATMENT DID SHE RECEIVE?

These thyroid function tests were obtained from a 65-year-old male who presents with tiredness.

Past history includes ischaemic heart disease and depression, for which he takes medication.

FT4 25 FT3 3.6 TSH 6.8

Which of the following is the most likely explanation for these results?

60-year-old female was prescribed thyroxine 150 microgrammes daily for hypothyroidism.She was clinically hypothyroid and no goitre was present.

She attends a follow up clinic and following are her results:

TOTAL T4 68 -T3 0.5 TSH 70

Which of the following would be the next step in her management?

40-year-old female with no prior history of thyroid disease presents with a five day history of an acutely painful, left-sided goitre. Clinically she appeared euthyroid, and was apyrexial.

TFT -WNL WBC 7000 PLT 2L ESR 12

What is the most likely diagnosis?

40-year-old female who has been prescribed thyroid replacement therapy has routine thyroid function tests.

On examination she appeared clinically euthyroid with no abnormal findings.

TSH 3.2 TOTAL T4-20 --/FT4 -2.6 FT3 2.5

Which one of the following statements is correct?

24-year-old female attends clinic complaining of numerous depigmented areas on the arms and legs. She is otherwise fit and well.

Which of the following diseases is most likely to accompany this skin condition?

18-year-old girl presents with anxiety and palpitations.

Her mother had received radioiodine for hyperthyroidism and was now on thyroxine replacement therapy.

On examination she had a pulse of 104 bpm with a fine tremor and lid lag. There was no goitre palpable.

FT4 -33 TSH 0.001 ANTI TPO AB -40

Most possible diagnosis

70-year-old female is diagnosed with anaplastic thyroid cancer.

What is the most likely consequence of this cancer?

34-year-old Man from UK presents with a six month history of tiredness, weight gain and cold intolerance.

On examination he appeared hypothyroid and had a firm goitre.

Investigations reveal: FT4- 6 TSH 55

What is the most likely diagnosis in this patient?

43-year-old female presents acutely unwell. She has 3 month history of weight loss, tiredness and lethargy which has deteriorated over the last week. 6 weeks previously she had been diagnosed with hypothyroidism by her GP. She had started thyroxine 50 µg daily but had deteriorated over the last two weeks.

No addictions no other Rx. Her mother and maternal grandmother have hypothyroidism and take thyroxine.

O/E she appears unwell and mildly dehydrated. Temp-37.5°C and has a BMI of 21.3 kg/m2. Her blood pressure is 72/44 mmHg, with a pulse of 100 beats per minute. ALL SYSTEMS WNL. Investigations are pending .

In the meantime what is the most appropriate immediate management of this patient?

80-year-old female presents to the ER acutely unwell after being found unresponsive, on the floor of her house,. She had a past history of hypothyroidism and of taking thyroxine daily. However, her compliance with treatment is questionable. She is not a known case of any other illness.

O/E she was unrousable with a GCS of 6/15, had a central temperature of 34°C, oxygen saturations of 95% on air, a pulse of 44 beats per minute and a blood pressure of 100/80 mmHg. There were no specific localising signs on neurological examination, but both plantars were extensor.

Prior to results of her emergency blood tests being available, what is the most appropriate immediate treatment for this patient?

25-year-old nurse presents with fatigue, fever, dysphagia tremulousness and a 3 kg weight loss over the past two weeks. On examination she has a tachycardia and fine tremor.

FT4 -40 TSH 0.01

Which one of the following would best support the diagnosis of de Quervain's thyroiditis?

50-year-old female presents with palpitations and slight weight loss.

She has an uneventful medical history but takes supplements that she buys in a health food shop. She is a non-smoker and drinks little alcohol. There is a maternal aunt who hypothyroid

On examination she has a pulse of 96 beats per minute and BP of 122/76 mmHg. She has fine tremor of the outstretched hands and there is slight lid lag but no exophthalmos. No goitre is palpable.

FT4 -29, FT3 5.3 , TSH 0.02,

THYROGLOBULIN UNDETECTABLE

What is the most likely diagnosis?

55-year-old female presents with a four hour history of fatigue and palpitations.

On examination she is vomiting, and is noted to have a slight tremor, some lid lag and has an irregularly irregular pulse of 140 per minute, blood pressure 110/75, with some fine basal crackles.

ECG confirms atrial fibrillation with a rate of approximately 130 per minute.

FT4 32 TSH 0.01

Which of the following is the most appropriate initial treatment for this patient

middle aged woman presents with new onset palpitations. She also commented that she had lost weight recently despite an increased appetite.

Examination reveals a goitre and a degree of exophthalmos. During physical examination she fell unconscious. Blood pressure was 70/40 mmHg.

Electrocardiogram revealed atrial fibrillation (AF) with rapid ventricular response.

What is the appropriate immediate management?

54 male admitted in CCU with ACS and Ventricular arrythmias on heparin protocol post PTCA was referred to you on day 4 of admission for opinion on altered TFT . He had no past history of thyroid illness

O/E there is no goiter or bruit

FT4 32 , TSH-2.1, ANTI TPO NEGATIVE , ANTI TSH NA

what is the most appropriate next step in management

38-year-old lady with hyperthyroidism was reviewed in the endocrine clinic.

She had initially presented to her general practitioner a month ago with flu-like symptoms and tremulousness. Her thyroid function tests at that time were consistent with hyperthyroidism and she was commenced on propranolol.

On examination, her pulse was 88 beats per minute and regular. She did not have any eye signs. She had a diffuse, tender goitre.

FT4 45, TSH 0.01 RAI < 2%

What is the most appropriate treatment?

25-year-old woman presents with galactorrhoea to expression. She has recently been discharged from the local psychiatric hospital where she was admitted for treatment of schizophrenia.

She has oligomenorrhoea and normal secondary sexual characteristics. She has gained about 19 kg in the past six months, despite no change in appetite. She has also noticed that her skin is excessively dry. Her past medical history includes migraine, gastro-oesophageal reflux and asthma.

TSH 54 PROLACTIN 278

What is the likely contributory pathology for her hyperprolactinaemia?

Which of the following predict the degree of upper airway obstruction with retrosternal extension of goiter