Endocrinology — MCQs

Q: Which of the following conditions is the most common complication of radioiodine treatment for Graves' disease?

Hypothyroidism. ***Hypothyroidism*** - **Radioiodine (RAI) therapy** destroys overactive thyroid cells, making it highly effective for Graves' disease but often leading to a permanent state of **hypothyroidism** post-treatment. - The goal of RAI is to eliminate the source of excess hormone production, and while effective, it frequently necessitates lifelong **thyroid hormone replacement**. *Thyroid storm* - **Thyroid storm** is a rare, life-threatening complication, usually seen in untreated or undertreated hyperthyroidism or during acute stress, not typically a direct outcome of effective RAI. - While a transient increase in thyroid hormones can occur shortly after RAI, a full-blown thyroid storm is infrequent with proper preparation and management. *Thyroid cancer* - There is no significant evidence to suggest an increased risk of **thyroid cancer** in adults following therapeutic doses of radioiodine for Graves' disease [1]. - The radiation dose is targeted primarily at the thyroid gland, and studies have shown no clear link to increased malignancy [1]. *Subacute thyroiditis* - **Subacute thyroiditis** (also known as de Quervain's thyroiditis) is typically a post-viral inflammatory condition of the thyroid, characterized by pain and tenderness in the thyroid gland [2]. - It does not directly result from radioiodine treatment; however, some patients may experience a transient inflammatory response (radiation thyroiditis) after RAI, which is usually mild and self-limiting, not true subacute thyroiditis.

Q: What is the management of choice for a case of Sheehan syndrome presenting with unresponsive hypotension?

Hydrocortisone. ***Hydrocortisone*** - **Unresponsive hypotension** in Sheehan syndrome is often due to **adrenal insufficiency** (ACTH deficiency), which requires immediate corticosteroid replacement [1]. - **Hydrocortisone** rapidly replaces cortisol, which is crucial for maintaining vascular tone and preventing hypotensive shock [1]. *Thyroxine* - While **hypothyroidism** can occur in Sheehan syndrome, **thyroxine** replacement acts slowly and is not an appropriate initial treatment for acute, life-threatening hypotension [1]. - Correcting profound hypotension takes precedence over addressing thyroid hormone deficiencies in an emergency. *Labetalol* - **Labetalol** is an **antihypertensive** agent that would worsen hypotension in a patient with Sheehan syndrome and adrenal crisis. - It would further decrease blood pressure and compromise circulation. *Epinephrine* - **Epinephrine** is a potent **vasopressor** and might be considered in extreme shock, but it is not the primary treatment for hypotension due to adrenal insufficiency. - Without adequate cortisol, the body is less responsive to catecholamines, making steroid replacement essential first.

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