Tiredness and abnormal blood tests
AMC Clinical practice station

The task

You are a general practitioner. Mrs Diane Kowalski, aged 58, saw you last week because of tiredness and you ordered blood tests. Results: TSH 24.0 mIU/L (reference 0.4 to 4.0), free T4 6 pmol/L (reference 9 to 19), total cholesterol 6.9 mmol/L, haemoglobin 128 g/L, sodium 136 mmol/L, fasting glucose normal. She has returned for the results. Ask what you need to, explain what the results mean, discuss the plan and answer her questions. The examiner will not take part in the conversation.

What this station tests

• State the diagnosis plainly first when results are clearly abnormal; do not make the patient wait through a long preamble.
• Link results to the patient's symptoms so the numbers have meaning.
• Ask about supplements; iodine-containing products such as kelp can affect thyroid tests and treatment.
• Address blame and cancer fears directly; they are common after a patient has searched online.
• Explain that thyroid replacement is monitored by repeat blood tests and the dose is adjusted.

Sources for the clinical content

• healthdirect: Hypothyroidism (underactive thyroid)
• Food Standards Australia New Zealand: Iodine in food and iodine requirements
• Medical Board of Australia: Good medical practice, a code of conduct for doctors in Australia

An original practice scenario with invented patients. Not an exam question.

Practise next

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