Question Easy: A 45-year-old woman presents with fatigue, weight gain, and cold intolerance. On examination, she has dry skin and a slow heart rate. You suspect hypothyroidism. Which initial blood test would confirm your diagnosis? 🩺
A) Serum TSH level
B) Serum T3 level
C) Serum T4 level
D) Serum calcium level
E) Serum prolactin level
Question Medium: A 60-year-old man presents with a history of recurrent headaches, visual disturbances, and elevated blood pressure. An MRI reveals a space-occupying lesion in the sellar region. Which hormone levels are most likely elevated if you suspect a pituitary adenoma causing acromegaly? 🧠
A) ACTH
B) Growth hormone
C) Prolactin
D) TSH
E) Cortisol
Question Hard: A 23-year-old woman is referred to endocrinology due to episodes of palpitations, sweating, and severe anxiety. She has lost 10 kg over the past three months. Her mother has a history of thyroid disease. You consider a diagnosis of Graves’ disease. Which specific antibody assay would support this diagnosis? 🧬
A) Anti-thyroglobulin antibodies
B) Anti-TPO antibodies
C) TSH receptor antibodies
D) Anti-insulin antibodies
E) Anti-mitochondrial antibodies
Explanations & Answers:
Question Easy Answer: A) Serum TSH level
Question Easy Explanation: In primary hypothyroidism, the serum thyroid-stimulating hormone (TSH) level is elevated due to the feedback mechanism. This is the most sensitive initial test according to NICE guidelines for assessing thyroid function.
Question Medium Answer: B) Growth hormone
Question Medium Explanation: Acromegaly is commonly caused by a pituitary adenoma secreting excess growth hormone. Measuring growth hormone, along with IGF-1 levels, aids in diagnosis. NICE guidelines recommend considering acromegaly in patients with characteristic clinical features.
Question Hard Answer: C) TSH receptor antibodies
Question Hard Explanation: Graves’ disease is an autoimmune disorder where TSH receptor antibodies are stimulating the thyroid, leading to hyperthyroidism. Testing for these antibodies assists in confirming the diagnosis as per NICE and NHS recommendations.
Medical fact of the day: Acromegaly can be tricky to diagnose early because its symptoms often develop slowly and are gradual. However, recognizing early changes such as increased ring size or shoe size can lead to earlier intervention.
Quote of the day: “In the tapestry of medicine, every patient is a story, and every diagnosis is a discovery—keep weaving the threads of hope and healing.”