Thyroid Meds Quiz Flashcards
Match the statements:
Thyroxine
Pituitary gland
Hypothalamus
Produces TRH which tells the pituitary to release TSH
Produces thyroid stimulating hormone
Thyroid cells combine iodine and tyrosine to make T3 and T4
Thyroxine - thyroid cells combine iodine and tyrosine to make T3 and T4
Pituitary gland - produces thyroid stimulating hormone
Hypothalamus - produces TRH which tells the pituitary to release TSH
T or F: An elevated TSH and a low T4 is consistent with primary hypothyroidism
True
In patients older than 60 years or in patients with coronary artery disease the oral starting dose of levothyroxine is:
A) 1.6 mcg/kg/day
B) 125 mcg per day
C) 25 mcg per day
D) 25 mg per day
C
In patients younger than 60 and without any cardiovascular disease the recommended oral starting dose is:
A) Usually between 88 mcg/day and 125 mcg/day depending on the patients weight
B) 200-300 mcg/day
C) 1.6 mg/kg/day
D) 60 mg/day
A
After initiation of levothyroxine you should reevaluate your patient and measure TSH:
A) Weekly
B) Monthly
C) Every 6-8 weeks
D) Annually
C
This question is about the timing of an oral dose of levothyroxine. Which statement is correct?
A) To save time, patients should take their “thyroid” at the same time as taking iron and or calcium supplements
B) Take their dose 30 minutes before a meal, or at least 4 hours after eating. OR take their dose at bedtime.
C) Take their dose 30 minutes after a meal or 4 hours before a meal
D) Patients should consult an attorney before their next appointment with you
B
Methimazole is an oral anithyroid agent. What is the mechanism of action of methimazole?
A) Inhibits TSH
B) Inhibits TRH
C) Inhibits thyroid peroxidase – methimazole is iodinated instead of thyroglobulin. Less iodide is converted to iodine
D) Methimazole inhibits parathyroid hormone
C
Hypocalcemia directly stimulates the secretion of which of the following?
A) Vitamin D
B) Angiotensin II
C) Parathyroid hormone
D) Norepinephrine
C
Which of the following physiological effects are not facilitated by thyroid hormone (T3 and T4)?
A) Basal metabolic rate
B) Red blood cell apoptosis
C) Appetite and GI motility
D) Gluconeogenesis and glycogenolysis
B
Which of the following acts to decrease serum calcium?
A) Vitamin D3
B) PTH
C) ACTH
D) Calcitonin
D
Your patient today is a 64 year old woman concerned about fatigue, sluggishness, and weight gain. Over the past month she needs to nap several times a day. She is taking levothyroxine for the past 12 years and has maintained her desired amount of energy for daily activities up until the past month.
Her recent history is significant for a diagnosis of arrhythmia and she is currently taking a medication to control this arrhythmia. Which medication would be the most likely cause for her current status?
A) Lidocaine
B) Amiodarone
C) Verapamil
D) Sotalol
B - amiodarone is an iodine containing anti arrhythmic agent with complex effects on the thyroid. Amiodarone inhibits peripheral conversion of T4 and T3. The other choices have no effect.
Propranolol also inhibits conversion to T3.
Which of the following is recommended?
A) TSH assessment should be performed within the first week of any levothyroxine dosage change and repeated weekly over the next 3-4 months
B) Reference ranges of serum TSH levels are lower in older populations, so lower serum TSH targets may be appropriate
C) Levothyroxine is contraindicated in patients receiving phenobarbital, phenytoin, or sertraline
D) If levothyroxine dose requirements are higher than expected, evaluation for gastrointestinal disorders is suggested
D - if levothyroxine dose requirements are much higher than expected, evaluate for GI disorders – H. pylori related gastritis, atrophic gastritis, celiac disease
If such disorders are detected and effectively treated, reevaluation of thyroid function and levothyroxine dosage is recommended
