Tutorial 4 Flashcards
Q: A 25-year old lady who had recently undergone a divorce presented to her GP. She was upset about this and wanted something to calm her down and help her to sleep. She had been very irritable for the last 18 months. On direct questioning she admitted to a history of palpitations, weight loss and sweating over the past year. Two aunts had previously undergone neck operations and she had noticed a swelling in her own neck over the past year.
On examination she had a fine tremor and looked thin. Her pulse rate was 112 beats/min and her blood pressure was 106/70 mmHg. She had a swelling in her neck which moved with swallowing. It was soft, extended symmetrically either side of the midline and was not tender to the touch. Her GP sent off a blood sample to the hospital to measure her thyroid function.
What is the diagnosis? List the clinical features to support your diagnosis. (7) Other symptoms. (2)
A: hyperthyroidism (high metabolic rate)
- weightloss,
- palpitations
- sweating
- neck swelling
- high pulse rate
- low bp (could be normal)
- fine tremor
- irregular light period
- loose stools
Q: Someone with hyperthyroidism. What do you think her thyroid function tests would show? (3)
A: low levels of TSH
high levels of T3 and 4
Q: A 32-year old woman presented to her GP with progressive tiredness over the last 2 years since the birth of her daughter. She wanted a vitamin preparation to give her more energy. She had been let go from her job as a cashier in her local supermarket 6 months earlier because her throughput of customers had slowed down so much. On direct questioning, she admitted to being constipated, intolerant of the cold and one stone heavier than before the birth of her child. Her periods were now much heavier and lasted longer than ever. There was no illness other than ischaemic heart disease in her family.
On examination she was pale, had an increased Body Mass Index (BMI) and appeared disinterested in her GP’s questions. Her pulse rate was 54 beats per minute and her blood pressure 110/75 mmHg. She had slow relaxing reflexes but there were no other abnormal findings on examination. Her GP sent off a blood sample to the hospital to measure her thyroid function.
What is the diagnosis? List the clinical features to support your diagnosis.
A: hypothyroidism (decreased metabolic rate)
- tired
- constipated
- intolerance to cold
- heavier periods (menorrhagia)
- pale
- low pulse rate
- slow relaxing reflexes (knee jerks up fast but comes down slower)
- appears disinterested
Q: Someone with hypothyroidism. What does their thyroid function test show?
A: high TSH
low T3 and T4
