QuestionSBA
QuestionChoice
There is no recognised interaction between sertraline and carbimazole
50130
e
To stop taking her sertraline
QuestionChoice
Smoking can potentially reduce the efficacy of hyperthyroidism treatment however this isn't the most important thing to tell her out of the options provided.
50128
c
To stop smoking
QuestionChoice
Treatment with carbimazole can cause bone marrow suppression. This is very serious side effect of carbimazole and needs to be mentioned when counselling on the drug. Any signs of infection, especially a sore throat should be reported immediately. After this, a full blood count should be taken. If this full blood count shows neutropenia then carbimazole should be stopped immediately.
50126
a
To report having a sore throat
QuestionChoice
Mood changes are not a recognised side effect of carbimazole treatment
50127
b
To report any changes to mood
QuestionChoice
Alcohol can still be consumed whilst taking carbimazole. This patient however is above the recommended weekly limit so should look to reduce her alcohol consumption if possible.
50129
d
To stop drinking alcohol
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3605
Carbimazole treatment increases the risk of agranulocytosis
Topic
92
General Practice
10073
Case Presentation: A 38-year-old woman attends a follow up appointment at her GP for the results of her blood tests.




 **PMH** Depression, Asthma


 **DH** Salbutamol 200 micrograms INH PRN, Sertraline 50mg PO OD. NKDA


 **SH** Active smoker, smoking 10 cigarettes a day (5 pack year history). Drinks 20-30 units of alcohol a week.


 **Investigations**


||||
|---------------------------|:-------:|------------------------------|
|Thyroid Stimulating Hormone|<0.1 mU/L|0.3 - 4.2|
|Free T4|44 pmol/L|9 - 25|
|Free T3|18 pmol/L|3.1 - 6.8|


Based on her blood results she is diagnosed with hyperthyroidism. It is decided that she will be started on carbimazole 15mg PO OD.


Question: Select the most appropriate piece of information that should be relayed to this patient prior to starting carbimazole
a