Endo SC

Question 1

Signs of Graves Disease

Answer 1

Complex ophthalmology
Clubbing
Thyroid acropachy
Pretibial myxedema
Exophthalmus
Proptosis

Question 2

Differentials for a multinodular goitre

Answer 2

Hyperthyroid state:
- Graves, toxic DeQuerveins, dyshormonogenesis (excess TSH stimulation i.e. THSoma)

Hypothyroid
- Hashimotos, DeQuerveins (post acute phase), simple goitre (iodine deficiency), goitrogens (following hyper phase)

Euthyroid
- physiological goitre (pregnancy, adolescence)

Question 3

Differentials for a solitary nodule

Answer 3

Hyperthyroid state:
- toxic adenoma

Euthyroid

• thyroid cyst
• thyroid adenoma or carcinoma
• thyroglossal cyst
• branchial anomalies

Question 4

4 features of acromegaly

5 complications of acromegaly

Answer 4

Large hands
Thickened skin
Frontal bossing and prognathism
Hirsutism

Arthropathy
Carpal tunnel syndrome
Cardiac - cardioomegaly, HTN, valvular disease (AR/MR)
Ocular - bitemporal hemianopia +/- optic atrophy (pituitary adenoma)
Gynaecomastia (compression of pituitary stalk)

Question 5

Investigation of acromegaly

Answer 5

IGF1 level
oral glucose supression test with GH (glucose normally supreses GH)
MRI-B