Question Easy: A 45-year-old woman presents with increased fatigue, weight gain, and cold intolerance. Her thyroid function test shows low free T4 and elevated TSH levels. Which condition does she most likely have? 🤔
A) Hyperthyroidism
B) Subclinical hypothyroidism
C) Euthyroid sick syndrome
D) Primary hypothyroidism
E) Secondary hypothyroidism
Question Medium: A 60-year-old man comes to the clinic with headaches and visual disturbances. MRI of the brain reveals a pituitary macroadenoma. Which of the following is the most appropriate initial treatment for a prolactinoma? 🩺
A) Radiation therapy
B) Bromocriptine
C) Surgical resection
D) Corticosteroids
E) Cabergoline
Question Hard: A 50-year-old woman presents with episodes of palpitations, sweating, and headaches. Her 24-hour urinary metanephrines are elevated 📈. Imaging shows a mass above the kidney. What is the most likely diagnosis?
A) Cushing’s syndrome
B) Conn’s syndrome
C) Pheochromocytoma
D) Addison’s disease
E) Neurofibromatosis
Explanations & Answers:
Question Easy Answer: D) Primary hypothyroidism
Question Easy Explanation: The patient exhibits classic symptoms of hypothyroidism, such as fatigue, weight gain, and cold intolerance. The combination of low free T4 and elevated TSH suggests primary hypothyroidism, where there is thyroid gland dysfunction leading to decreased thyroid hormone production. NICE guidelines point to these lab findings as indicative of primary hypothyroidism.
Question Medium Answer: E) Cabergoline
Question Medium Explanation: For prolactinomas, which are pituitary tumors secreting excess prolactin, the first-line treatment according to NICE guidelines and BNF is dopamine agonists such as cabergoline or bromocriptine. Cabergoline is typically preferred due to a more favorable side-effect profile and dosing convenience. Surgery is reserved for cases where medical therapy fails or if the tumor causes neurological deficits.
Question Hard Answer: C) Pheochromocytoma
Question Hard Explanation: The described symptoms and elevated urinary metanephrines, along with the adrenal mass, are characteristic of pheochromocytoma. This is a rare adrenal medulla tumor that secretes catecholamines, causing symptoms like palpitations, headaches, and sweating. Early recognition and management in specialized centers, as advised by NHS guidelines, are essential due to potential complications such as hypertensive crises.
Medical fact of the day: Did you know that about 1 in 10 people over the age of 40 in the UK show some signs of thyroid dysfunction, with hypothyroidism being the most common? It’s often managed well with levothyroxine, reducing the risk of cardiovascular complications.
Quote of the day: “In the world of healing, every small gesture of care and compassion becomes a cornerstone of recovery. Keep building those bridges, one kind act at a time.”