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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 76–80 (page: 17)

A 72-year-old woman presented with a painless swelling in the front of the neck, which she had first noticed 2– 3 months previously. She was otherwise well, with no symptoms of mass effect in her neck, and was not taking any medication.
On examination, her thyroid gland was moderately enlarged, and felt uniformly nodular. There was no associated lymphadenopathy. Her pulse was 78 beats per minute and regular, and there were no signs of thyrotoxicosis.

Investigations:
-serum thyroid-stimulating hormone<0.01 mU/L (0.4–5.0) serum free T424.8 pmol/L (10.0–22.0)
-serum free T310.3 pmol/L (3.0–7.0)
-technetium-99m scan of thyroid (20-min uptake)patchy uptake in both thyroid lobes

What is the most appropriate management?

A 24-year-old man was referred for investigation of infertility. He had been having unprotected intercourse with his partner for 18 months, but the couple had failed to conceive. He had been treated for Hodgkin’s lymphoma at the age of 17.
What is the most appropriate investigation?

A 76-year-old woman with type 2 diabetes mellitus was reviewed. Treatment with thiazolidinedione was being considered, but she was worried about the effect this medication might have on the incidence of complications. She had known background retinopathy.What complication is more likely to worsen in a patient taking a thiazolidinedione?

A 62-year-old woman was referred with difficulty in swallowing and a painful, swollen neck.
On examination, her neck was tender to palpation with a small, diffuse goitre. There was no associated neck lymphadenopathy.

Investigations:
-serum thyroid-stimulating hormone<0.04 mU/L (0.4–5.0) serum free T426.0 pmol/L (10.0–22.0)
-serum free T312.0 pmol/L (3.0–7.0)

What is the most likely diagnosis?

A 17-year-old boy with a 7-year history of type 1 diabetes mellitus was transferred to the adolescent diabetes clinic. He had a history of poor clinic attendance. He admitted to having lost weight recently. His eyes had been photographed by a community ophthalmologist 1 week previously. A photograph of the right fundus is shown (see image).



Investigations:
haemoglobin A1c104 mmol/mol (20–42)
What is the most likely explanation for the retinal appearance?