Endocrinology

Question 1

Investigation results in Graves disease

Answer 1

High T4, low TSH
Non-tender goitre
Nuclear scintigraphy - uniform uptake with diffuse enlargement

Question 2

Investigation results in subacute thyroiditis (De Quervain’s)

Answer 2

High T4, low TSH
Raised ESR
Tender goitre
Associated recent viral illness

Question 3

Investigation results in sick euthyroid syndrome (non-thyroidal disease)

Answer 3

Low T4, low/normal TSH
After recent period of illness

Question 4

Toxic multinodular goitre investigations

Answer 4

Low TSH, high T4
Patchy uptake on nuclear scintigraphy

Question 5

Paget’s disease of the bone

Answer 5

Increased uncontrolled bone turnover
Excessive osteoclast resorption followed by increased osteoblastic activity
Most commonly affects skull, spine/pelvis, long bones

Question 6

Presentation of Paget’s disease of bone

Answer 6

Usually asymptomatic
Stereotypically older male with bone pain and isolated raised ALP
Bone pain - pelvis, lumbar spine, femur
Bowing of tibia
Frontal bossing of skull

Question 7

Management of Paget’s disease of the bone

Answer 7

Not everyone needs treatment
Bisphosphonate

Question 8

Osteoporosis management

Answer 8

First line - oral bisphosphonates
If had a hip fracture then IV zoledronate first line
Second line - denosumab
Other options - strontium ranelate, raloxifene, terparatide, romosozumab

Question 9

Bone mineral density cut off following DEXA

Answer 9

T score of -2.5 or below

Question 10

Bisphosphonate guidance

Answer 10

Should be on PO bisphosphonates for at least 5 years or IV for 3 years then re-assess fracture risk
PO should be taken with full glass of water on an empty stomach and patient should stay sat upright for 30 mins afterwards

Common SE - oesophagitis, hypocalcaemia, osteonecrosis of the jaw, atypical femoral fractures