Margaret Thyroid Disorders

96-112. Identify each of the following findings as associated with hyperthyroidism, hypothyroidism, or both.

96-112. Identify each of the following findings as associated with hyperthyroidism, hypothyroidism, or both.

84. Which of the following medications is a helpful treatment option for relief of tremor and tachycardia seen with untreated hyperthyroidism? A. propranolol B. diazepam C. carbamazepine D. verapamil

A. propranolol (symptom management for hyperthyroidism)

81. Which is following is the least helpful test for the assessment of thyroid disease? A. total T4 B. thyroid-stimulating hormone (TSH) C. free T4 D. thyroid peroxidase (TPO) antibodies

A. total T4

79. A 48-year-old woman with newly diagnosed hypothyroidism asks about a "natural thyroid" medication she read about online and provides the drug's name: desiccated thyroid. As you counsel her about this medication, you consider all of the following except: A. this product contains a fixed dose of T3 and T4. B. the medication is a plant-based product. C. its pharmacokinetics differ significantly when compared to levothyroxine. D. the majority of the study on treatment for hypothyroidism has been done using levothyroxine.

B. the medication is a plant-based product.

95. Periodic routine screening for hypothyroidism is indicated in the presence of which of the following clinical conditions? A. digoxin use B. male gender C. Down syndrome D. alcoholism

C. Down syndrome

88. You advise a 58-year-old woman with hypothyroidism about the correct use of levothyroxine. She also takes a calcium supplement. All of the following should be shared with the patient except which instruction? A. "Take the medication on an empty stomach." B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication." C. "You should take the medication at approximately the same time every day." D. "Do not take your medication with soy milk."

B. "To help with adherence, take your calcium supplement at the same time as your thyroid medication."

80. Hypothyroidism most often develops as a result of: A. primary pituitary failure. B. thyroid neoplasia. C. autoimmune thyroiditis. D. radioactive iodine exposure.

C. autoimmune thyroiditis.

82. Physical examination findings in patients with Graves' disease include: A. muscle tenderness. B. coarse, dry skin. C. eyelid retraction. D. delayed relaxation phase of the patellar reflex.

C. eyelid retraction.

91. Which of the following is the most cost-effective method of distinguishing a malignant from a benign thyroid nodule? A. ultrasound B. magnetic resonance (MRI) imaging C. fine-needle aspiration biopsy D. radioactive iodine scan

C. fine-needle aspiration biopsy

78. Increased risk of thyroid disorder is found in individuals who are: A. obese. B. hypertensive. C. treated with systemic corticosteroids. D. elderly.

D. elderly.

113. The use of which of the following medications can induce thyroid dysfunction? A. sertraline B. venlafaxine C. bupropion D. lithium

D. lithium

87. In the report of a thyroid scan done on a 48-year-old woman with a thyroid mass, a "cold spot" is reported. This finding is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid cyst.

D. thyroid cyst.

90. A fixed, painless thyroid mass accompanied by hoarseness and dysphagia should raise the suspicion of: A. adenomatous lesion. B. Graves' disease. C. Hashimoto's disease. D. thyroid malignancy.

D. thyroid malignancy.

TSH less than 0.15 mIU/L (0.4 to 4.0 mIU/L); free T4 = 79 pmol/L (10 to 27 pmol/L)

Hyperthyroidism

TSH = 24 mIU/L (0.4 to 4.0 mIU/L); free T4 = 3 pmol/L (10 to 27 pmol/L)

Hypothyroidism

TSH = 8.9 mIU/L (0.4 to 4.0 mIU/L); free T4 = 15 pmol/L (10 to 27 pmol/L)

Subclinical hypothyroidism

93. At minimum, at what interval should TSH be reassessed after a levothyroxine dosage is adjusted? A. 1 to 2 weeks B. 2 to 4 weeks C. 4 to 6 weeks D. 6 to 8 weeks

D. 6 to 8 weeks

86. TSH is released by the: A. thyroid follicles. B. adrenal cortex. C. hypothalamus. D. anterior lobe of the pituitary.

D. anterior lobe of the pituitary.

107. hyporeflexia with a characteristic slow relaxation phase, the "hung-up" reflex

hypothyroidism

108. coarse hair with tendency to break easily

hypothyroidism

109. thick, dry nails

hypothyroidism

110. constipation

hypothyroidism

89. The findings of a painless thyroid mass and TSH level of less than 0.1 IU/mL in a 35-year-old woman is most consistent with: A. autonomously functioning adenoma. B. Graves' disease. C. Hashimoto's disease. D. thyroid malignancy.

A. autonomously functioning adenoma.

92. Possible consequences of excessive levothyroxine use include: A. bone thinning. B. fatigue. C. renal impairment. D. constipation.

A. bone thinning.

83. The mechanism of action of radioactive iodine in the treatment of Graves' disease is to: A. destroy the overactive thyroid tissue. B. reduce production of TSH. C. alter thyroid metabolic rate. D. relieve distress caused by increased thyroid size.

A. destroy the overactive thyroid tissue

100. secondary hypertriglyceridemia

hyporthyroidism

102. coarse, dry skin

hypothyroidism

94. As part of an evaluation of a 3-cm, round, mobile thyroid mass, you obtain a thyroid ultrasound scan revealing a fluid-filled structure. The most likely diagnosis is: A. adenoma. B. thyroid cyst. C. multinodular goiter. D. vascular lesion.

B. thyroid cyst.

111. atypical presentation in an elderly person

Both

112. change in mental status

Both

98. goiter

Both

103. menorrhagia

hypothyroidism

85. In prescribing levothyroxine therapy for an elderly patient, which of the following statements is true? A. Elderly persons require a rapid initiation of levothyroxine therapy. B. TSH should be checked about 2 days after dosage adjustment. C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults. D. TSH should be suppressed to a nondetectable level.

C. The levothyroxine dose needed by elderly persons is 75% or less of that needed by younger adults.

101. amenorrhea or oligomenorrhea

hyperthyroidism

104. hyperreflexia with a characteristic "quick out-quick back" action at the patellar reflex

hyperthyroidism

105. proximal muscle weakness

hyperthyroidism

106. tachycardia with hypertension

hyperthyroidism

96. heat intolerance

hyperthyroidism

97. smooth, silky skin

hyperthyroidism

99. frequent, low-volume, loose stools

hyperthyroidism