Diabetes and endocrine therapeutics
Practice questions with explanations

A. Severe thyrotoxicosis with fever, agitation, tachycardia and confusion, suggesting thyroid storm

Thyroid storm is a life-threatening decompensation often precipitated by infection, surgery, trauma or iodine load, and it needs immediate treatment with beta-blockade, thionamides, iodine and supportive care. Myxoedema coma is the hypothyroid equivalent. Both are rare but recognisable, and delay in recognition is what makes them fatal.

B. Rapid progression to insulin, weight loss, ketosis, or a personal or family history of autoimmune disease suggesting latent autoimmune diabetes

Latent autoimmune diabetes in adults is slowly progressive autoimmune beta cell destruction that is initially mistaken for type 2 diabetes, and antibody testing and C-peptide clarify it. Recognition matters because these patients progress to insulin dependence and are at risk of ketoacidosis if treated as though they have type 2 diabetes.

A. On an empty stomach with water, at least 30 minutes before food, and separated from calcium and iron by 4 hours

Levothyroxine absorption is reduced by food, coffee, calcium, iron, and proton pump inhibitors that raise gastric pH, so a consistent empty-stomach routine matters as much as the dose. Calcium and iron are chelating culprits and need a four-hour gap. Because the half-life is about a week, changes are assessed by TSH no sooner than six weeks after a dose change, and consistency of brand is also worth maintaining.