Question 1

Treatment of a patient with hypothyroidism and cardiovascular disease consists of:

Accepted Answer

Levothyroxine is the treatment of choice for hypothyroidism and is safe to use in patients with cardiovascular disease. Liothyronine and liotrix are not preferred as they have a shorter half-life and may lead to fluctuations in thyroid hormone levels. Methimazole is used to treat hyperthyroidism, not hypothyroidism.

Question 2

When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in:

Accepted Answer

The correct answer is 4 weeks. This is the recommended time frame for the first follow-up measurement of thyroid function after starting levothyroxine therapy. This allows for evaluation of the effectiveness of the initial dose and adjustments can be made as needed. Subsequent follow-up measurements can be done at 6-8 week intervals until the patient's thyroid function is stable on the medication.

Question 3

What is the desired mixed of T3 to T4 drug levels in newly diagnosed endocrine patients?

Accepted Answer

Most endocrine patients require a higher proportion of T4 to mimic the natural ratios of hormone in the body. T4 has a longer half-life and is converted to T3 in the body as needed. This ensures that the body has a steady supply of thyroid hormones over a longer period of time, which is important for maintaining thyroid function.

Question 4

Why are "natural" thyroid products not readily prescribed for most patients?

Accepted Answer

The answer of Why are "natural" thyroid products not readily...

Question 5

A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with:

Accepted Answer

Propylthiouracil (PTU) is the preferred treatment for pregnant women with hyperthyroidism as it can be used during all three trimesters and has a lower risk of causing birth defects compared to methimazole. Radioactive iodine is contraindicated during pregnancy and delaying treatment until after pregnancy ends can lead to complications for both the mother and baby.

Question 6

Infants with congenital hypothyroidism are treated with:

Accepted Answer

Infants with congenital hypothyroidism are treated with Levothyroxine, also known as synthetic T4, as it is the primary hormone produced by the thyroid gland. This medication is initiated as soon as possible after diagnosis to prevent long-term developmental delays and cognitive impairment. Liothyronine (synthetic T3) and Liotrix (combination of T3 and T4) are not commonly used in the treatment of congenital hypothyroidism. Methimazole is a medication used to treat hyperthyroidism, not hypothyroidism.

Question 7

After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every:

Accepted Answer

After starting a patient with Grave's disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every 3 to 4 weeks. This allows for adjustments in dosage and monitoring of efficacy and potential adverse effects.

Question 8

When methimazole is started for hyperthyroidism it may take ________ to see a total reversal of hyperthyroid symptoms.

Accepted Answer

The answer of When methimazole is started for hyperthyroidism it...

Question 9

When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include:

Accepted Answer

Education should include that it may take 4 to 8 weeks for the patient to feel relief of symptoms and for laboratory testing to show improvement. This is important for managing patient expectations and preventing unnecessary dose adjustments or medication changes.

Answer: D
 Levothyroxine has a long half-life, however, due to its narrow therapeutic window, doses should not be missed to avoid fluctuating thyroid hormone levels which can affect symptom management and increase the risk of adverse effects. It is important for patients to understand the importance of adherence to their medication regimen.

Therefore, both options C and D are correct.

Question 10

Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true?

Accepted Answer

The therapeutic range for TSH is typically kept between 0.05 and 3.0, whereas screening values are considered acceptable up to 10. Therefore, option C is the correct answer. Options A, B, and D are all inaccurate.

Question 11

Goals when treating hypothyroidism with thyroid replacement include:

Accepted Answer

The goals of treating hypothyroidism with thyroid replacement therapy include achieving normal TSH and free T4 levels, resolving symptoms such as fatigue, and helping patients return to their baseline weight, among other things. Therefore, all of the options listed are correct goals of treatment.

Question 12

In hyperthyroid states, what organ system other than CV must be evaluated to establish potential adverse issues?

Accepted Answer

In hyperthyroid states, the eye must be evaluated as there is a potential risk for Grave's ophthalmopathy, which can lead to vision loss or eye-related complications. This is due to the autoimmune process affecting the eye muscles and tissues. While the liver may be affected, it is not as crucial to evaluate in terms of potential adverse issues as the eye. Nails, skin, and ear are not directly affected by hyperthyroidism.

Question 13

What happens to the typical hormone replacement dose when a woman becomes pregnant?

Accepted Answer

During pregnancy, the body's demand for hormones increases due to the physiological changes and the needs of the developing fetus. Therefore, the average woman needs more medication to maintain proper hormone levels.

Question 14

In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for:

Accepted Answer

A beta blocker is the best choice for a symptomatic patient with hyperthyroidism because it can quickly alleviate symptoms like rapid heart rate, tremors and anxiety. Calcium channel blockers and alpha blockers are not typically used for hyperthyroidism, and liothyronine is already a thyroid hormone replacement medication which is not used for the initial management of hyperthyroidism.

Question 15

Once a patient who is being treated for hypothyroidism returns to euthyroid with normal TSH levels, he or she should be monitored with TSH and free T4 levels every:

Accepted Answer

Once a patient with hypothyroidism returns to euthyroid with normal TSH levels, monitoring with TSH and free T4 levels every 6 months is recommended. This frequency allows for early detection of any changes in thyroid function and adjustment of medication if necessary.

Quiz 41: Hyperthyroidism and Hypothyroidism