chap 41: Hyperthyroidism & Hypothyroidism

Question 1

1. When methimazole is started for hyperthyroidism it may take ________ to see a total reversal of hyperthyroid symptoms.
2. 2 to 4 weeks
3. 1 to 2 months
4. 3 to 4 months
5. 6 to 12 months

Answer 1

4. 6 to 12 months

Question 2

2. In addition to methimazole, a symptomatic patient with hyperthyroidism may need a prescription for:
3. A calcium channel blocker
4. A beta blocker
5. Liothyronine
6. An alpha blocker

Answer 2

2. A beta blocker

Question 3

3. After starting a patient with Grave’s disease on an antithyroid agent such as methimazole, patient monitoring includes TSH and free T4 every:
4. 1 to 2 weeks
5. 3 to 4 weeks
6. 2 to 3 months
7. 6 to 9 months

Answer 3

2. 3 to 4 weeks

Question 4

4. A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with:
5. Methimazole
6. Propylthiouracil (PTU)
7. Radioactive iodine
8. Nothing, treatment is best delayed until after her pregnancy ends

Answer 4

2. Propylthiouracil (PTU)

Question 5

5. Goals when treating hypothyroidism with thyroid replacement include:
6. Normal TSH and free T4 levels
7. Resolution of fatigue
8. Weight loss to baseline
9. All of the above

Answer 5

4. All of the above

Question 6

6. When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in:
7. 2 weeks
8. 4 weeks
9. 2 months
10. 6 months

Answer 6

2. 4 weeks

Question 7

7. 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:
8. 2 weeks
9. 4 weeks
10. 2 months
11. 6 months

Answer 7

4. 6 months

Question 8

8. Treatment of a patient with hypothyroidism and cardiovascular disease consists of:
9. Levothyroxine
10. Liothyronine
11. Liotrix
12. Methimazole

Answer 8

1. Levothyroxine

Question 9

9. Infants with congenital hypothyroidism are treated with:
10. Levothyroxine
11. Liothyronine
12. Liotrix
13. Methimazole

Answer 9

1. Levothyroxine

Question 10

10. When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include:
11. They should feel symptomatic improvement in 1 to 2 weeks.
12. Drug adverse effects such as lethargy and dry skin may occur.
13. It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing.
14. Because of its short half-life, levothyroxine doses should not be missed.

Answer 10

3. It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory testing.

Question 11

11. In hyperthyroid states, what organ system other than CV must be evaluated to establish potential adverse issues?
12. The liver
13. The nails and skin
14. The eye
15. The ear

Answer 11

3. The eye

Question 12

12. Why are “natural” thyroid products not readily prescribed for most patients?
13. There is no reliability for the amount of hormone per dose.
14. There is higher incidence of allergic reactions.
15. There is a more reliable dose of T3 to T4 per batch.
16. All of the above

Answer 12

4. All of the above

Question 13

13. What is the desired mixed of T3 to T4 drug levels in newly diagnosed endocrine patients?
14. 99% of T3 and the rest is T4 to get rapid resolution.
15. Most needs to be T4 to mimic natural ratios of hormone.
16. The ratio is unimportant.
17. The mix needs to be 50-50 at first.

Answer 13

2. Most needs to be T4 to mimic natural ratios of hormone.

Question 14

14. Laboratory values are actually different for TSH when screening for thyroid issues and when used for medication management. Which of the follow holds true?
15. Screening TSH has a wider range of normal values 0.02-5.0; therapeutic levels need to remain above 5.0.
16. Screening values are much narrower than the acceptable range used to keep a person stable on hormone replacement.
17. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10.
18. Screening values are between 5 and 10, and therapeutic values are greater than 10.

Answer 14

3. Therapeutic values are kept between 0.05 and 3.0 ideally. Screening values are considered acceptable up to 10.

Question 15

15. What happens to the typical hormone replacement dose when a woman becomes pregnant?
16. Most women need less medication.
17. Most women do not require a dose change.
18. The average woman needs more medication during pregnancy.
19. The average woman needs more medication only if carrying multiples.

Answer 15

3. The average woman needs more medication during pregnancy.