Assessing Endocrine Disorders

Question 1

Explain these thyroid function test results

Answer 1

If T3 and T4 are high then TSH must reduce. If TSH is still high, hay a problem w the pituitary gland bc its not sensing thyroid hormone levels
If T4 and T3 are high but TSH is low this=primary hyperthyroidism
If T4 and T3 are low but TSH is high=primary hypothyroidism
If T3 and T4 are low but TSH is low, hay a problem w the pituitary gland bc its not sensing thyroid hormone levels

Question 2

How are thyroid nodules and Goitre investigated?

Answer 2

Thyroid Nodule
Ultrasond Scan
FNA
CT neck

Goitre
Thyroid Function
Ultrasound
CXR
CT/MRI

Question 3

Describe the classification of thyroid nodule ultrasound investigation

Answer 3

Question 4

What is the synacthen test?

Answer 4

Short Synacthen (250mcg)
Blood taken over 1 hour
Used to diagnose primary adrenal failure

Long Synacthen Test (1mg)
Blood taken over 24 hours
Used to diagnose secondary adrenal failure

Question 5

What does this shorth synacthen test show?

Answer 5

Question 6

What does this Long synacthen test show?

Answer 6

Question 7

What is the oral glucose tolerance test?

Answer 7

Take blood sample for GH and IGF-1

Give the patient a solution of 75 grams oral glucose

Take blood and measure GH and glucose at 30, 60, 90 and 120 minutes

A synacthen test can be carried out at the end of this test

Question 8

How do you interpret oral glucose tolerance test results to diagnose acromegaly?

Answer 8

In normal individuals, GH levels fall following oral glucose, and at least one of the samples during the test should have undetectable GH levels.

Failure of suppression or a paradoxical rise in GH suggests acromegaly.

Following treatment safe level of GH < 1.0mU/l (0.4ng/ml)

Question 9

Interpret the result of these oral glucose tolerance tests

Answer 9