OET Writing practice · Medicine
Uncontrolled Graves' disease – endocrinologist
An original practice task written by LetterScore AI. Read the case notes in 5 minutes, then write your referral letter in 40 minutes, about 180–200 words in the body.
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Case notes
MEDICINE — WRITING TASK (practice) Time allowed: Reading time 5 minutes, Writing time 40 minutes Read the case notes below and complete the writing task which follows. Notes: Today's date: 09/09/2026 You are a GP at Kingsmead Medical Centre, 55 Abbey Road, Norbridge. Patient: Ms Priya Nair, DOB 08/03/1992 (34 yrs) Social background: - Primary school teacher. Lives with partner (Arjun) - Smoker, 5 cigarettes/day; attempted to stop 2025 - Alcohol approx. 4 units/week - Gym 3×/week until June (stopped due to palpitations) - Couple hoping to try for a baby "next year" Family history: - Mother: hypothyroidism. Maternal aunt: type 1 diabetes Medical history: - Childhood asthma; no inhalers since age 16 - Migraine with aura (2020) - Contraception: copper IUD (2023) - Sprained R ankle (2024) - NKDA Consultation notes: 06/07/2026 - c/o palpitations, heat intolerance, tremor, anxiety, loose stools; wt loss 5 kg over 3 months (now 56 kg) - O/E: HR 112 reg, BP 132/70. Fine tremor. Diffuse smooth goitre with bruit, no nodules. Mild lid retraction, no proptosis, eye movements full - TSH <0.01 mU/L, FT4 42 pmol/L (12–22), FT3 16.8 pmol/L (3.1–6.8) - Plan: TSH receptor antibodies (TRAb), FBC, LFT - Propranolol 40 mg TDS; carbimazole 20 mg daily (following endocrinology advice line) - Agranulocytosis warning given (sore throat/fever → urgent FBC) 13/07/2026 (results) - TRAb 8.4 IU/L (positive; <1.8). Neutrophils 3.2 × 10⁹/L. LFT normal - Dx: Graves' disease 10/08/2026 - Palpitations improved. HR 88. Wt 55 kg - Adherence good (pill organiser checked) - FT4 35 pmol/L, FT3 12.1 pmol/L - Carbimazole increased to 40 mg daily - Watery eyes in wind; lubricant drops advised 09/09/2026 - Tired; still heat intolerant. Wt 54 kg. HR 96 reg - Itchy urticarial rash on arms and trunk × 10 days, started after dose increase; cetirizine 10 mg daily gives partial relief - Eyes gritty; partner thinks R eye "more prominent". Mild periorbital puffiness. VA 6/6 both eyes, colour vision normal, no diplopia - FT4 30 pmol/L, FT3 10.4 pmol/L. Neutrophils 2.4 × 10⁹/L. ALT 38 U/L (normal) - Asks about pregnancy and treatment options - Tension headache after parents' evening; paracetamol Assessment: - Graves' disease not controlled after 9 weeks of carbimazole - Probable carbimazole-related rash - Early/mild thyroid eye disease Plan: - Refer to endocrinology: review of antithyroid drug; discuss radioiodine/surgery - Continue carbimazole 40 mg, propranolol and cetirizine pending review - Smoking cessation strongly advised (eye disease risk); referred to stop-smoking service - Continue contraception; avoid pregnancy until advised by specialist - Urgent review if sore throat, fever or change in vision Writing Task: Using the information in the case notes, write a letter to Dr Richard Blake, Consultant Endocrinologist, Thyroid Clinic, Norbridge Royal Infirmary, 12 Castle Street, Norbridge, requesting review of Ms Nair's management. In your answer: - Expand the relevant notes into complete sentences - Do not use note form - Use letter format The body of the letter should be approximately 180–200 words.
How to approach this referral letter
- The reader has never met the patient. State the reason for referral, and how urgent it is, in the first paragraph.
- Select the history, findings and investigation results that support the referral, and group them by topic rather than by date.
- End with what you are asking the reader to do, and any action you have already taken.
Members also get the model answer, the note-selection table and task-specific tips for this task.