Whats going on?
This antibody is the key reason for autoimmune thyroid destruction in hashimotos
What is anti-TPO
This is the most important question to ask regarding loss of weight history
What is intentionality
These are the three age appropriate cancer screening for a 60 year old lady with loss of weight
What are scopes, mammogram and HPV DNA
This is the food specifically highlighted in my slides as high in iodine
What is seaweed
Mdm Ong is a 41 year old female who presents to your clinic with 6kg weight loss over the past 4 months with occassional palpitations and trembling
What is graves
Along with dry mucous membranes, mouth ulcers and loss of hair, loss of weight is a common symptom for this class of conditions
What is autoimmune
These are the three easiest questions to ask to screen for thyroid symptoms (5 correct answers but give me 3)
What are temperature intolerance, bowel changes, appetite, weight changes and mood
This is the direction you would expect TSH and T4 to move in in secondary hypothyroidism
What is down
This is the set of counselling you need to give for CMZ
What is agranulocytosis, teratogenesis and drug induced lupus (i will accept if no lupus)
Mr Zhang is a 65 year old male who presents with 8kg weight loss over the past 6 months, he feedbacks to you that his leg has been very swollen and he wakes up frequently due to breathlessness
What is CHF
This medication while useful in ACLS may cause thyroid dysfunction
What is amiodarone
These are questions you would ask for mass effect in a thyroid patient
What are neck pain, hoarseness of voice, difficulty swallowing and breathlessness
This is the cause of LOW which can be seen in CXRs that may be commonly found on a pirate ship
What is lung metastases AKA cannonball lesions
This is the set of non pharm measures you would offer to a patient with LOW secondary to poor feeding
What is feeding assistance, dietitian referral and speech therapist evaluation
Mr Lim is a 34-year-old man presents to clinic with a 4-month history of unintentional weight loss of approximately 8 kg, accompanied by intermittent fevers, night sweats, and chronic non-bloody diarrhea lasting over a month. On examination he has non tender lymphadenopathy
What is HIV
This is a cause of failure to thrive which will eventually resolve in puberty
What is constitutional growth delay
These are the questions you may ask for secondary hypo/hyperthyroidism (4 correct answers, give me 3)
What are vision changes, menstrual irregularities, headaches and galactorrhea
This is the step typically offered in an abdominal exam that may be more relevant in a patient with loss of weight
What is DRE
This is the supermarket item which is the culprit of low T4 levels in patients on levothyroxine replacement
What is milk
Mdm Lee, a 80 year old female who presented with weight gain and constipation a few weeks ago now presents to the ED with altered mental state, HR 55, RR 7, BP 85/55
What is myxedema coma
A patient has been taking levothyroxine but their thyroid levels have not been improving. When asking about their medication that they take concurrently, these are the three medications you need to ask for (5 correct answers but just give me 3)
What are calcium, iron, aluminium antacids, cholestyramine and PPIs
These are 6 out of the 9 broad classes of symptoms I listed in my systems review slide for loss of weight
What are constitutional, infection, GI, psych, hyperthyroid, autoimmune, cardiac, respi and hepatic
This is the name of the scale used to assess whether thyrotoxicosis is a thyroid storm
What is the burch wartofsky point scale (bonus points for naming the four components)
This is the broad overarching principle behind thyroid medication
What is titrate to euthyroid state
Mr Zaki is a 45 year old man who presented with loss of weight of 9kg over the past 4 months. He presents with frequent headaches and also he often has dizzy spells and bluriness of vision. You check his blood sugar and his current blood sugar is 4.1 mmol/L. You check his T4 and TSH levels and they are both low. You also notice his shirt is stained near the chest area. (Hint: two diagnoses are at play here, difficult diagnosis)
What is MEN1 syndrome (Pituitary Adenoma + Insulinoma)