Thyroid and Parathyroid Gland Disorders — WACS Viva & Clinical Scenarios (Endocrinology, Diabetes, and Metabolism)

Exam-style thyroid and parathyroid gland disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 32-year-old woman with poorly controlled Graves disease presents to the emergency department with severe agitation, hyperpyrexia (temperature 40.2°C), marked sinus tachycardia at 160 beats per minute, atrial fibrillation, vomiting, and jaundice. Outline your immediate diagnostic criteria using the Burch-Wartofsky Point Scale and describe your sequential resuscitation and pharmacological protocol.
• SCENARIO 2: A 42-year-old woman presents with a 4-month history of heat intolerance, weight loss, bilateral proptosis, and a smooth diffuse neck swelling with an audible vascular bruit. Discuss your diagnostic workup, differentiating Graves disease from toxic multinodular goitre and subacute thyroiditis, and outline your medical management plan including risks, monitoring, and safety instructions for antithyroid drug therapy.
• SCENARIO 3: A 50-year-old man is found on routine neck ultrasonography to have an incidental, solid, hypoechoic thyroid nodule measuring 1.8 cm with microcalcifications and irregular margins. Detail the risk stratification using the ACR TI-RADS criteria, interpret fine needle aspiration cytology results using the Bethesda classification system, and formulate a surgical versus surveillance management plan.
• SCENARIO 4: A 58-year-old woman presents with altered mental status, severe constipation, abdominal pain, polyuria, and profound dehydration. Her serum adjusted calcium is 3.85 mmol/L (reference 2.15 to 2.55 mmol/L) with a serum intact parathyroid hormone level of 185 pg/mL (reference 15 to 65 pg/mL). Formulate your emergency medical resuscitation strategy for severe hypercalcaemia and detail your diagnostic and definitive surgical pathway for primary hyperparathyroidism.
• SCENARIO 5: A 68-year-old woman is brought to the emergency department during the harmattan season with profound lethargy, periorbital puffiness, non-pitting peripheral oedema, hypothermia (core temperature 33.4°C), bradycardia (pulse 42 beats per minute), and severe respiratory depression. Explain your diagnostic criteria for myxoedema coma and your comprehensive intensive care management ladder.