SCA practice case · Video consultation
“Tired, and not just tired”
Video consultation
Adult patient
Straightforward
Investigations & resultsGender, reproductive & sexual health
The candidate brief
This is what you would read in the 3-minute window before the patient connects. Read it once, note two or three hypotheses and one thing you must not miss, then stop.
Patient
Hana Yilmaz · 31 years · female
Setting
Video consultation — fatigue; TFTs back abnormal.
Past history
- Nil significant
Medication
- Nil regular
- No contraception
Allergies
NKDA
Recent notes
⚠ TSH 22 mU/L, FT4 7.1 pmol/L (low), TPO antibodies strongly positive. FBC, ferritin, B12, coeliac, glucose normal.
Reason for contact
Results follow-up. “Is there a tablet that gives me my life back?”
Practise this case
The full case is in the Hot Seat with the Gold plan. You get a 12-minute timer, a role-player script with facts released only when asked, examiner checkpoints by the three RCGP domains, a model consultation and the guidance behind it.
What this case tests
Show the learning points (spoiler: read after you have practised)
Overt primary hypothyroidism (high TSH, low T4, positive TPO = Hashimoto’s) in a young healthy adult is replaced with a full weight-based levothyroxine dose (NICE NG145: 1.6 micrograms/kg/day, rounded to the nearest 25 micrograms, in adults under 65 without cardiovascular disease), taken fasting, rechecked early and then 3-monthly until stable, and titrated to target. That is the easy half. The marks live in the hidden agenda: a tiredness appointment is really a 14-month conception story carrying self-blame and forum-fuelled fear. Surface it, then deliver the counter-intuitive reframe — finding treatable hypothyroidism is GOOD news for fertility, not a verdict of brokenness — and adjust the plan: pre-conception TSH aim ≤2.5 mU/L and a 25–30% dose increase (e.g. two extra doses a week) with prompt thyroid tests as soon as pregnancy is confirmed (RCOG Green-top Guideline, 2025), folic acid 400 micrograms (NICE NG247), and fertility assessment for both partners now (NICE NG257). Lift the blame with evidence and share the load.
The guidance behind it
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