#5 Thyroid disease

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All you need to do to sign up is go to pacesahead.com and I advertise for these two sponsors because I genuinely believe that combined they essentially guarantee you'll get that all important parts in Paces. So use the discount code Pre Paces 15 at quesimed.com and sign up today! Hello and welcome along to this episode of the Pre Paces podcast with me Dr Sam Williams where we help you fulfil your exam potential in the MRCP. Today we discuss thyroid disease with consultant endocrinologist Dr. Jodie Sabin who gave us an amazing insight into how thyroid disease can cut in paces and how best to structure your approach to these patients. We really appreciate all the feedback we get from you guys so if you enjoy the podcast or want to suggest a topic for future episodes then let us know on Twitter and Instagram at Pre Paces podcast or Pre Paces [email protected]. Don't forget to subscribe to the show wherever you get your podcasts so you don't miss an episode. We know some of you will have exams coming up very soon so all the best of luck to those you sitting and most importantly we hope you enjoy the show. Welcome to the Pre Paces podcast. The only podcast that's half radio knowledge and half kumaran clarts clinical medicine. My name is Dr. Sam Williams and I want to thank you for joining us for today's episode where we're discussing a topic which always gave me wide eyes and a big lump in my throat every time I thought about it and that is thyroid disease. Today I'm joined by Dr. Jodie Sabin. Jodie is a consultant in endocrinology and diabetes at Gloucester and Chelten hospitals and has taught many paces candidates over the years including me. Jodie thank you so much for joining us today and I guess thyroid disease is something you see on a fairly regular basis. Yeah absolutely so thyroid disease is very common and particularly in our outpatient setting and it's probably one of the most common things that we deal with on a daily basis. And it's something which we know has come up again time and time again in paces so there's no doubt that hopefully this will come in handy for our listeners. So Jodie's going to be guiding us through the approach to thyroid disease in paces how it might be presented to us and then as usual we'll talk through some common examiner questions on investigations and management and not only that but quiz the consultant is back. Every consultant guest who comes on the podcast is subjected to a quick fire quiz on a specialist subject of their choosing with a proviso that it can't be related to medicine. So Jodie what have you named as your specialist subjects and why? So why won't we put a great picture spake off on the principle that I figured most people will probably have seen it and it's the only thing I could think of that might provide a bit of entertainment and the irony is not lost on us all. Yeah so without further ado let's jump into the action and talk about thyroid disease. So thyroid disease can mainly be found in the context of the station five and those are the brief clinical consultations where there's two 10 minute stations in sequence. It could also be found in the context of the longer history taking station but we're going to be discussing it in the context of a station five but a lot of the things that we talk about will be transferable to a longer more comprehensive history taking station. So just to recap for the listeners Jodie station five you get five minutes before the station where the candidates get to read a scenario about what they're going to see they'll then have eight minutes to take a history perform a focused examination and then explain the management plan to the patients and after that they have two minutes of examiner questions. So Jodie starting right at the beginning what sort of notes in the scenario before you even enter the station might tip the candidates off that this is a thyroid-centered station. So there's certainly a few different things that can present so one of the more common presentations that issues for station five is certainly thyroid eye disease. It may be something like this patient's presenting with discomfort in their eyes or difficulty moving their eyes or that they might have made it's a change in their appearance of their face. So those are sort of clues that might make you start thinking about is this thyroid disease. It's a very common thing so it's very easy for them to find patients who will still have ongoing signs even if they just you know it's been treated and sort of way down the line. So I think it's one of the more common things that you may come across is definitely worth just always having at the back of your mind. The other thing that might present is that they've told you that the patients got a neck lump or that they've noticed some tenderness or some swelling in their neck and that may also be a leading to again thinking about the thyroid. The other thing will be if people have got specific symptoms so weight loss or palpitations or anxiety or tremors that tends to be sort of the main sort of cohort of sort of presentations but obviously they're very not specific and don't sort of get sort of too sort of tunnel vision in terms of thinking about the firewood with those because obviously that can also apply to lots of different situations as well. It affects lots of different parts of you so it can present in lots of different ways so it's just having an open mind about thinking about the firewood with any sort of presentation really. And the other thing to note about those three distinct presentations, thyroid eye disease, necklumps and a thyroid toxic patient or a patient reporting or symptoms of thyroid disease is that it's important for you to ask about each of those individually regardless of what the preceptor complaint is. Oh yeah and absolutely if you've got some of the who you think has got a thyroid problem that you need to make sure that you cover all of those things because that's all relevant to the patient and it will guide you in terms of your management and how you approach things so just even if they're present with their eye disease you still want to ask them about the rest of their thyroid status and likewise they're present with a necklump and don't just focus on the neck you need to think about the other aspects through it all as well so. Excellent so specifically in a patient who as part of the scenario mentions they have puffy eyes or have noticed a bulging of the eyes. What are the key things that you want to ask early in the station to demonstrate you've got a good understanding of thyroid eye disease? So like facing the stock with a basics and what's the thing that's bothering the patient the most and because it might be that they've lost their vision it might be that they've actually just needed some discomfort in their eyes it might be some redness or swelling so you know find out what's what's most important to the patient first of all and then going on from there so you really want to make sure that you've demonstrated that you understand all of the problems of thyroid eye disease can cause even if it's not relevant for that individual. So often the most common presentation we see in clinic is very subtle signs of thyroid eye disease so it can just be a little bit of swelling it can be a little bit of redness a bit of discomfort and often feels like the lot of patients like a bit like allergic conjunctivitis and a lot of them won't necessarily have realised that face symptoms are due to their thyroid so they're often think it's hay fever or you know kind of things in the environment and so it's just trying to get a bit of a clear pitch about when these problems start is if this is something they've had for years and it's you know every summer with hay fever then you can probably be reassured that that's what it is but if this is something completely new that's only been happening over the last few months then obviously you need to start thinking about what else is going on and having it at the back of your mind that this may not be something that's straightforward. In a more extreme case some people will have problems moving their eyes so ask them whether they've had any problems with their eye movements do they feel that they restricted in any way have they lost any parts of their vision working out whether they can still you know have no more visual focus and can they still read things properly and all of these things are relevant in terms of knowing how quickly you want to do something about the problem that they've got. You've mentioned there about the limitation of eye movement and possible sort of double vision or diplopia secondary to that. Are there any other sort of red flag signs which would make you think this patient is quite unwell and they need urgent referral to an ophthalmologist imminently either the same day or you know within a week or so. Yeah so the meaning you're worried about is that these got visual loss so the part of the problem is if I don't see if they get a lot of inflammation so that inflammation can cause inflammation of the muscles and that can cause restriction of eye movements i'wch chi'n ei gallu'r gwybod y gallu'r gwaithio o'r gwaithio o'r gwaithio o'r gwaithio i'n eiwchio'r gwaithio o'r gwaithio. Mae'r gwaithio gwaithio'r gwaithio o'r gwaithio yn eiwchio'r gwaithio yn eiwchio'r gwaithio. Mae'r gwaithio gwaithio, yw'r gwaithio, yn eiwchio'r gwaithio. Mae'n gwaithio yw'r gwaithio. Mae'n gwaithio'r gwaithio i'n gwaithio'r gwaithio yna i'wchio'r gwaithio. Mae'r gwaithio gwaithio i'wchio'r gwaithio i'wchio'r gwaithio i'wchio'r gwaithio. Mae'r gwaithio i'wchio'r gwaithio i'wchio'r gwaithio. Mae'r gwaithio i'wchio'r gwaithio i'wchio'r gwaithio i'wchio'r gwaithio. Mae'r gwaithio i'wchio'r gwaithio. dar siesta'n rydwyt nhw'n fawr但ael ei maw honourable cy Season fear y 不ain o po rate o dynostura. 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We all know that consultants are experts in their field, but what else occupies the brilliant minds of our consultants that isn't medicine? I'm asking each and every consultant who comes on the show to give me a specialist subject of their own choosing with one goal and rule that it isn't anything to do with medicine at all. And whoever comes out on top at the end of the series will bag a coveted pre-paces podcast mug. So, Jody, remind us again what have you chosen as your specialist subject and why? That's where I picked the great British Bake-Up, basically they watch the show and it's about the only thing I could think of that might appeal to everybody else as well. So, we'll see. And are you much of a bake yourself? I do enjoy baking when I have time. I don't go to quite the same levels that they do on the show. I don't get decorated, that's for sure. So, we are giving you the opportunity to win a coveted pre-paces podcast mug. The rules are the 10 questions. And if you answer without taking the multiple choice options, you'll get two points. But if you're struggling, you can ask for four multiple choice options. And if you get it after that, you get one point. So, there's 20 points in total that you could get. So, 10 quick fire questions on the Great British Bake-Up. Are you ready? Yeah, go for it. Question number one. In what year was the first series of the Great British Bake-Up? So, if it just had the 10-year anniversary, so I think it was 2010. Correct for two points. Question number two. In each episode, the bakers face three challenges. The signature, the technical and what other challenge? The show stop a challenge. And that is correct for another two points. Question number three. Who were placed Mary Berry as judge on the show in 2017? That was proully. Another two points. Question number four, what channel did Bake Off move to in 2017 from the BBC? Channel four. That is correct. Again, is this going to be a clean sweep? Question number five, name one of the two spin-off shows, Broadcasting the UK, that start with great. That's in not a baking show. It's, yeah, so it's one of the spin-off shows from the Bake Off. That include the, it's the great. The great British 7B. Yes, correct. Another two points. Question number six, in 2017, Prue Leaf upset fans of the show in an off-screen controversy. What happened? She announced the winner on Twitter before the show was out. Absolutely correct. Question seven. An episode four of series five, Ian, threw his bake in the bin after what went wrong. And I think that was something to do with the ice cream melting. I can't remember what they were making, but I think it's something to do with something having frozen properly. Okay, I'm going to give you the two points. It was, you're absolutely correct. It was the baked Alaska. After this happened, what did Ian present to the judges? I think he just handed me the big, didn't he? He did. Correct. He handed them the bin with his ruined bake in it. Question number nine, we're on for a clean sweep. In the 2020 series, who replaced Sandy Toxwig as host? Oh, Matt Lucas. That is correct. Question 10. What is the show known as in the USA? Oh, I don't know this one. I don't know. You'd have to give him more choices. I'll give you, I'll give you the options. Is it a the American baking competition? B the USA baking bananza. C the American dream bake or D the big American show about baking? And a is a which gives you a near perfect score of 19 out of 20. She is leading the way in quiz the consultant with a near perfect score. Jodie, thank you so much for joining us on quiz the consultant. And thank you so much for giving us all your expertise related to thyroid disease and baking. And it's clear you've chosen the specialist subject for you. I thought it was a good sign or not. Perfect. So thank you so much for joining us, Jodie. It's been it's been really great to hear from an esteemed expert about everything to do with thyroid disease. So thank you so much for joining us today. That's okay. You're welcome. And it's always a pleasure to bring you these episodes when we're joined by someone who's an esteemed expert. So if you like the podcast, please like, comment and subscribe on Apple podcasts on Spotify or wherever you get your podcasts. And you can also get in touch via the usual social media channels on Twitter and Instagram. It's at prepaces podcast or on email it's [email protected]. Thank you so much for listening and we'll see you next time on the prepaces podcast.