Palpitations

Question 1

Less thought of symptoms of hyperthyroid

Answer 1

Fatigue
Exertional dyspnea- Increased oxygen consumption
Depression
Hyperreflexia
Diarrhea
Light periods

Question 2

More common signs of hyperthyroid in patients > 70

Answer 2

Sinus tach
Fatigue
Atrial fibrillation
Weight loss
- Only a couple may be present

Question 3

Exopthalmos

Answer 3

Associated with graves

Can be bilateral or unilateral

Question 4

TSH inappropriately normal

Increased T4

Answer 4

Pituitary adenoma or Thyroid hormone resistance

Question 5

Mild TSH elevation

Normal T4

Answer 5

Subclinical hypothyroid

Question 6

Decreased TSH

Decreased T4

Answer 6

Central or pituitary hypothyroid

Question 7

Decreased TSH
Normal T4
Increased T3

Answer 7

T3 Toxicosis

Question 8

Antibody involved in graves

Answer 8

Thyrotropin receptor antibodies

Thyroid stimulating immunoglobulins

Question 9

Graves: Men or women

Answer 9

Women 5 to 10

Question 10

Graves: Age

Answer 10

40 to 60

Question 11

Graves: Triggers

Answer 11

Stress
High iodine
Recent preg

Question 12

Less well know signs of hypothyroid

Answer 12

Pedal edema
Heavy periods
Fatigue- Common in both hypo- & hyper-

Question 13

Eliciting lid lag

Answer 13

Move finger from upper to lower field of vision

- The eyelid will drag behind the iris

Question 14

Tachycardia, tremulousness, irritability, weakness, and fatigue

Answer 14

Anxiety vs Hyperthyroid

Question 15

Positional dizziness

Answer 15

Arrhythmia vs Anemia

Question 16

Radioactive Iodine Uptake Study > 30%

Answer 16

Graves
Multi-nodular goiter
Toxic solitary nodule
TSH-secreting pituitary tumor
HCG secreting tumore

Question 17

Radioactive Iodine Uptake Study

Answer 17

Sub-acute thyroiditis
Silent thyroiditis
Iodine induced
Exogenous L-thyroxine
Struma ovarii
Amiodarone

Question 18

Diffuse RAIU

Answer 18

Graves

- Nodular uptake pattern = Multi-nodular or single nodule

Question 19

Are antibodies to thyroid peroxidase specific for Graves?

Answer 19

No, Hashimoto’s can have them as well

Question 20

Role of US in hyperthyroidism

Answer 20

Evaluation of nodules
FNA guidance
Doppler can be used to evaluate for Graves

Question 21

What test has not role in the DX of hyperthyroid disease

Answer 21

MRI

Question 22

Medications used to treat Graves

Answer 22

Methimazole: Most common

- Caution agranulocytosis

Question 23

How long does it take to suppress thyroid hormone?

Answer 23

Up to 3 months

- Symptoms can improve by 1 month

Question 24

How long do patient need to be treated for (graves)?

Answer 24

years

Question 25

Why do patients need frequent blood work (graves)?

Answer 25

Check for agranulocytosis

Dose needs to be adjusted to fit thyroid level

Question 26

What medication is more commonly used to suppress thyroid hormone in the US?

Answer 26

Radioactive iodine

• Few side effects, but can worsen eye symptoms
• Eventually destroys thyroid tissue
• Patients will eventually need to take thyroid hormones

Question 27

How often should thyroid hormone levels be checked in patients with hypothyroidism?

Answer 27

Once or twice a year

Question 28

What test needs to be done prior to starting radioactive iodine?

Answer 28

UPT

- The iodine can impact the thyroid of the fetus

Question 29

How often should TSH be checked after starting radioactive iodine?

Answer 29

q2 to 3 months until stable

- Can go to 6+ months after that

Question 30

Typical starting dose for hypothyroid?

Answer 30

1. 5 to 1.8 mcg/kg

- Increase dose slowly, especially in elderly

Question 31

When should TSH be repeated after starting a thyroid medication?

Answer 31

6 weeks