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IMF-024-01-0001-en	What roles do thyroid peroxidase and colloid play in producing and storing thyroid hormone?	Thyroid peroxidase oxidises iodide, attaches it to tyrosines in thyroglobulin and couples iodinated residues into thyroxine and triiodothyronine; colloid stores hormone extracellularly until endocytosis and proteolysis release it.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0002-en	How does free thyroid hormone change tissue function, and what regulates its production?	Free hormone enters cells and binds nuclear receptors, altering transcription that affects heat production, oxygen use, metabolism, cardiac responsiveness and growth; thyroid-stimulating hormone supports synthesis under negative feedback from free hormone.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0003-en	How do paired thyroid-stimulating hormone and free thyroxine results distinguish primary from central hypothyroidism?	Primary disease gives high thyroid-stimulating hormone with low free thyroxine, whereas in central disease from pituitary or hypothalamic failure thyroid-stimulating hormone is inappropriately low or normal.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0004-en	Why should iron, calcium, food and gastrointestinal disease be considered when setting a levothyroxine dose?	They reduce levothyroxine absorption, and absorption is one of the factors, with body composition, age, cardiac disease, pregnancy and residual function, that determine the replacement dose.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0005-en	What does management of myxoedema coma require in addition to urgent thyroid hormone?	Glucocorticoid cover until adrenal status is safe, supportive care, and treatment of triggers, because it is severe decompensation with hypothermia, hypoventilation, bradycardia, hypotension and altered consciousness.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0006-en	How do Graves disease, toxic nodules, thyroiditis and exogenous hormone each produce thyrotoxicosis?	Graves disease stimulates the thyroid-stimulating hormone receptor, toxic nodules secrete autonomously, thyroiditis releases stored hormone, and exogenous hormone bypasses synthesis.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0007-en	How does radionuclide uptake help identify the cause of thyrotoxicosis, and why cannot ultrasound replace it?	Increased uptake indicates active synthesis, whereas low uptake suggests destructive thyroiditis or exogenous hormone; ultrasound answers structural questions but does not replace biochemical classification.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0008-en	Why does fever or sore throat in a patient taking a thionamide require urgent blood assessment?	Thionamides can cause agranulocytosis, one of their serious adverse effects alongside hepatic injury.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0009-en	Which features raise concern about a thyroid nodule, and how is it evaluated?	Compression, suspicious nodes, radiation history, rapid growth, voice change or high-risk imaging raise concern; evaluation uses thyroid-stimulating hormone, ultrasound risk assessment and selective needle sampling.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0010-en	How is the output of each adrenal cortical zone controlled?	The zona glomerulosa makes aldosterone under angiotensin two and potassium, the zona fasciculata makes cortisol under adrenocorticotropic hormone, and the zona reticularis produces adrenal androgens.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0011-en	How does aldosterone alter electrolyte handling in the distal nephron?	It acts in principal cells to increase sodium reabsorption and potassium secretion, and promotes hydrogen secretion indirectly and in intercalated cells.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0012-en	What stimulates renin release, and what suppresses the renin-angiotensin system?	Renin is released in response to reduced renal perfusion, reduced sodium chloride at the macula densa, and sympathetic stimulation; volume expansion suppresses the system.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0013-en	What hormone pattern distinguishes primary from central adrenal failure?	Primary failure destroys the cortex, giving cortisol and aldosterone deficiency with high adrenocorticotropic hormone and renin; central failure reduces adrenocorticotropic drive and usually preserves aldosterone.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0014-en	Why does hyponatraemia not distinguish primary from central adrenal insufficiency, and which features point to primary disease?	Hyponatraemia occurs in both forms through impaired water excretion, whereas hyperpigmentation, salt craving, hyperkalaemia and marked volume depletion suggest primary disease.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0015-en	How should suspected adrenal crisis be managed with respect to diagnostic testing?	Treatment must not be delayed for testing: take samples only if immediately possible, then give parenteral hydrocortisone, isotonic fluid, glucose when required, and treat the precipitant.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0016-en	How is endogenous Cushing syndrome divided by mechanism?	It is adrenocorticotropic-dependent when pituitary or ectopic secretion drives it, or independent when an adrenal lesion produces cortisol; overall, iatrogenic exposure is the most common cause of the syndrome.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0017-en	What do Cushing syndrome screening tests assess, and what must happen before the source is localised?	They assess loss of normal suppression, excess free cortisol or a disrupted midnight nadir; abnormal results must be confirmed and exogenous exposure excluded before adrenocorticotropic hormone and imaging localise the source.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0018-en	Why may a patient need glucocorticoid replacement after Cushing syndrome is cured?	Normal adrenal tissue suppressed during the excess may need time to recover, so temporary glucocorticoid replacement may be required.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0019-en	How does laterality determine treatment in primary aldosteronism?	Unilateral disease may be treated surgically, whereas bilateral disease usually receives mineralocorticoid-receptor blockade.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0020-en	Why can total calcium misrepresent calcium status, and what is preferred when uncertainty is critical?	Albumin binds a substantial fraction of calcium, so total calcium changes with albumin and pH; direct ionised calcium measurement is preferable.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0021-en	How does parathyroid hormone respond to falling ionised calcium, and through which actions does it restore calcium?	It rises, increasing renal calcium reabsorption, phosphate excretion and active vitamin D production, and increasing bone resorption when persistently elevated.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0022-en	What are the components of managing severe symptomatic hypercalcaemia?	Restore volume, give rapid antiresorptive or calcium-lowering therapy according to cause, and monitor kidney and cardiac status; long-term management treats the source.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0023-en	Why is intravenous calcium for severe symptomatic hypocalcaemia given with cardiac monitoring?	Hypocalcaemia causes QT prolongation as well as tetany, seizures and laryngospasm, so severe symptoms need intravenous calcium under cardiac monitoring.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending
IMF-024-01-0024-en	How do osteoclasts, osteoblasts and osteocytes divide the work of remodelling, and when does remodelling weaken bone?	Osteoclasts resorb bone, osteoblasts form osteoid and support mineralisation, and osteocytes sense load; remodelling repairs microdamage, but excessive resorption weakens architecture.	Integrated Medical Foundations; chapter 24, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 3acd1af15beac51ba8776a309f8d3a107904d9a757b3c62dd341dcfbfe3278a4; editorial review pending	imf lang::en chapter::024 module::024-01 review::pending