1. SHORT CASE HISTORY
By Dr. Zahoor

2. CASE 1 – Topic: Thyroid Gland
A 50 year old woman is referred to out patient because she feels tired all the time. On further questioning, she has noticed constipation and thinning of her hair. On examination, she appears pale, over weight and has a smoothly enlarged thyroid gland. Full blood count shows Hb – 10.5g/dL and mean cell volume (MCV) – 100 fL.

3. Case 1 - Questions
1. On further examination she is most likely to demonstrate which of the following? a. Sinus tachycardia b. Sinus bradycardia c. Pigmentation of the skin creases d. Exopthalmos 2. What are biochemistry tests likely to show? a. Decreased T4 and Increased TSH b. Increased T4 and decreased TSH c. Decreased T4 and decreased TSH d. Increased T4 and increased TSH

4. Case 1 - Questions
3. Which of the following drug treatment may also cause hypothyroidism? a. Digoxin b. Aspirin c. Insulin d. Amiodarone

5. Case 1 - Answers
Answer to Question 1. b. Sinus bradycardia Answer to Question 2. a. Decreased T4 and Increased TSH Answer to Question 3. d. Amiodarone Note – Amiodarone treatment may cause either hypo or hyper thyroidism due to its high iodine content and structural similarity to thyroxin

6. CASE 2 – Topic: Thyroid Gland
A 35 year old woman is transferred to casualty with an irregular heart beat. On examination, she is sweaty and warm, but finds it difficult to sit still. She is noted to have staring eyes and can not write her name and address legibly. On examination, patient is in Aterial fibrillation at a rate of 110 beats/min. She has difficulty raising her arms above her head. The thyroid gland is slightly enlarged and has an audible bruit.

7. Case 2 - Questions
1. Biochemistry is most likely to show which of the following? a. Positive islet cell antibodies b. Increased T4 and increased TSH c. Increased T4 and decreased TSH d. Decreased T4 and Increased TSH 2. Following a likely diagnosis of Graves’ disease, a thyroid uptake scan is performed. What does this show? a. A diffusely ‘cold’ gland due to reduced uptake b. A diffusely ‘hot’ gland due to increased uptake c. A single ‘cold’ nodule d. Multiple ‘hot’ spots

8. Case 2 - Questions
3. What is the appropriate first line treatment of the underlying condition? a. Emergency thyroidectomy b. Radio-iodine c. Antithyroid drugs d. Thyroxine

9. Case 2 - Answers
Answer to Question 1. c. Increased T4 and decreased TSH Answer to Question 2. b. A diffusely ‘hot’ gland due to increased uptake Answer to Question 3. c. Antithyroid drugs (Carbimazole or Propylthiouracil)

10. Thank you