Question 1

What endocrine conditions do GPs manage?

Accepted Answer

GPs manage the majority of endocrine conditions including thyroid disorders, type 2 diabetes, osteoporosis, PCOS, and obesity. Less common conditions such as Addison's disease, acromegaly, and pituitary disorders are initially suspected and referred by GPs based on clinical features and first-line investigations.

Question 2

When should TFTs be checked in primary care?

Accepted Answer

TFTs should be checked in patients with fatigue, unexplained weight change, palpitations, mood disturbance, or menstrual irregularity. Routine monitoring is indicated for patients established on levothyroxine (annually once stable), and those on amiodarone or lithium (every 6 months).

Question 3

What is the FRAX score and when is it used?

Accepted Answer

FRAX calculates the 10-year probability of major osteoporotic fracture using clinical risk factors with or without bone mineral density. NICE NG187 recommends treatment thresholds based on age-specific intervention levels — patients above the threshold should receive first-line bisphosphonate therapy such as alendronate.

Question 4

How do I start levothyroxine for hypothyroidism in primary care?

Accepted Answer

Start at 1.6 mcg/kg/day in healthy adults under 60. In the elderly or those with cardiac disease, start at 25–50 mcg/day and titrate slowly. Recheck TSH at 6–8 weeks after initiation or any dose change, targeting TSH 0.5–2.5 mU/L, and recheck annually once stable.

Question 5

What are the sick day rules for adrenal insufficiency?

Accepted Answer

Patients on long-term steroids or with known adrenal insufficiency should double their steroid dose for 48–72 hours during significant illness, surgery, or injury. If vomiting prevents oral medication they require IM hydrocortisone 100 mg and emergency hospital admission to avoid an Addisonian crisis.

Question 6

Which weight loss medications are available on the NHS?

Accepted Answer

Semaglutide (Wegovy) is approved per NICE TA1026 for BMI ≥35 with weight-related comorbidities, or BMI 30–34.9 in specific high-risk groups. Tirzepatide (Mounjaro) is approved per NICE TA1051 with similar criteria. Both are initiated via specialist NHS weight management services.

TSH	Free T4	Free T3	Diagnosis	GP Action
↑ High	↓ Low	↓ Low	Primary Hypothyroidism	Start levothyroxine; recheck TFTs in 6–8 weeks
↑ High	Normal	Normal	Subclinical Hypothyroidism	If TSH >10 or symptomatic → treat; otherwise monitor 3–6 monthly
↓ Low	↑ High	↑ High	Primary Hyperthyroidism	Radionuclide scan, start carbimazole; refer endocrinology
↓ Low	Normal	Normal	Subclinical Hyperthyroidism	Recheck in 3–6 months; investigate if persists (scan, Ab)
Normal	Normal	Normal	Euthyroid	No action; reassess if symptoms change
↓ Low	↓ Low	↓ Low	Central Hypothyroidism	Pituitary axis failure — cortisol first, then LT4; urgent endocrinology
↑ High	↑ High	↑ High	TSH-secreting adenoma / Resistance	Rare — do not start antithyroid without specialist review

Endocrinology

Endocrinology in General Practice — Key Messages

Thyroid Function Test (TFT) Interpretation