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SEND - Endocrinology and Diabetes (Specialty Certificate Examination) Questions 91–95 (page: 20)

A 53-year-old man with a history of sweats and tremor was found to have abnormal thyroid function tests and a small diffuse goitre. He was treated with carbimazole 20 mg but developed a sore throat after 3 weeks.

Investigations:
-haemoglobin150 g/L (130–180)
-white cell count2.0 ? 109/L (4.0–11.0) neutrophil count0.4 ? 109/L (1.5–7.0)
-serum thyroid-stimulating hormone<0.02 mU/L (0.4–5.0) serum free T429.0 pmol/L (10.0–22.0)
-thyrotropin receptor antibodiespositive

The carbimazole was stopped; his sore throat resolved and the full blood count normalised. What is the most appropriate next step in management?

An 18-year-old woman was referred by her general practitioner for further investigation of “funny turns” during which she developed palpitations, sweating, tremor, hunger, anxiety and paraesthesiae; all of these symptoms were relieved immediately by a sugary drink.
She was otherwise well and was not taking any regular medication. There was a family history of type 1 diabetes mellitus. A spontaneous hypoglycaemic episode had not been captured and she was admitted to the diabetes/endocrine ward for a 72-hour fast. Her renal function was normal.
After a 12-hour fast she experienced her typical symptoms. Urinalysis showed no urinary ketones.

Investigations after 12-h fast:
fasting plasma glucose 2.0 mmol/L (3.0–6.0) plasma insulin56 pmol/L (<21 after hypoglycaemia) serum C- peptide514 pmol/L (180–360)

What is the most appropriate next step in management?

A 33-year-old woman was reviewed in the insulin pump clinic. She had had type 1 diabetes mellitus for 10 years. She had been treated with a continuous subcutaneous insulin infusion 3 years previously, because of frequent hypoglycaemic episodes. She had recently undergone continuous glucose monitoring (see image).



Investigations:
haemoglobin A1c43 mmol/mol (20–42)

What is the most likely cause of the blood glucose trace seen between 08.00 h and 10.00 h?

A 26-year-old woman presented with recurrent Graves’ disease. After discussing the treatment options, she chose radioiodine.
What dose of radioiodine is most appropriate in uncomplicated Graves’ disease?

A 17-year-old boy was concerned about his height. He had been treated for Crohn’s disease since the age of 13 with a combination of topical and systemic corticosteroids and azathioprine. He was currently taking mercaptopurinE.
On examination, his height was on the 25th centile. Investigations:
X-ray of right kneesee image



What is the most appropriate next step in management?