Pituitary and thyroid disorders

Question 1

Question 1 of 8

Janelle, a 30-year-old woman, presents at her primary care office complaining of feeling nervous and anxious. She states that she even feels as if her heart is racing because she is “so stressed out.” Janelle would like to be prescribed antianxiety medication.

Janelle’s height and weight measurements reveal she has lost 15 pounds in the last 6 months. She attributes her weight loss to stress.

What hormone disorder may lead to weight loss?
Thyroid hyperfunction
Thyroid hypofunction
Central diabetes insipidus
Posterior pituitary hyperfunction

Answer 1

Thyroid hyperfunction

Thyroid hormone hyperfunction is commonly associated with weigh loss as thyroid hormones regulate body metabolism. Hyperthyroidism causes an elevation in the basal metabolic rate, which may result in significant weight loss.

Question 2

Question 2 of 8

You examine Janelle and notes her resting heart rate is 84 beats per minute and blood pressure is 144/88 mm Hg. Which hormone may increase resting heart rate and blood pressure?
Oxytocin
Growth hormone
Thyroid hormone
Antidiuretic hormone

Answer 2

Thyroid Hormone

Thyroid hormones have a stimulatory effect on cardiac tissue. Thyroid hormone increase would be the most likely to account for the increase in heart rate and blood pressure.

Question 3

Question 3 of 8

You note slight tremors in Janelle’s hands, and an area in her neck appears to be enlarged compared with its appearance in previous visits. Janelle lists further complaints, including hair loss, diarrhea, and “feeling hot all the time.” Which of the following is true?
Parathyroid gland enlargement normally appears in the anterior neck area.
You should manually palpate Janelle’s neck with moderate force to assess the size of the tissue.
Enlargement of the thyroid gland can make the neck area appear “fuller” than normal.
Any enlargement of the thyroid gland indicates the presence of thyroid cancer, which is likely Janelle’s diagnosis.

Answer 3

Enlargement of the thyroid gland can make the neck area appear “fuller” than normal.

When the thyroid gland enlarges, changes in the appearance of the neck may be noticeable. Janelle’s neck should not be palpated with force as this can cause further damage to the thyroid gland. The parathyroid glands are located behind the thyroid, not on the anterior neck. An enlarged thyroid gland can occur for many reasons, not necessarily cancer.

Question 4

Question 4 of 8

Based on your assessment, the physician decides to have several blood tests completed. All results are normal except the following: significantly elevated thyroid hormone levels (free T3 and free T4) and undetectable TSH and TRH. What endocrine disorder does Janelle most likely have?
Primary thyroid hypofunction
Secondary thyroid hyperfunction
Tertiary thyroid hyperfunction
Primary thyroid hyperfunction

Answer 4

Primary thyroid hyperfunction

Janelle’s condition is hyperthyroidism as indicated by the elevated thyroid hormone levels. The condition is primary, a problem in the thyroid gland, because TSH levels (the signal from the anterior pituitary that stimulates the thyroid gland) are low.

Question 5

Question 5 of 8

Further screening reveals elevated thyroid-stimulating antibodies. What condition is Janelle experiencing?
Hashimoto’s thyroiditis
Cushing’s syndrome
Graves’ disease
SIADH

Answer 5

Graves’ disease

Elevated thyroid hormone levels can occur for a variety of reasons. Determining the underlying etiology of the elevated hormones is key for treatment. In this case, Janelle is experiencing an autoimmune disease known as Graves’ disease. In Graves’ disease, there are excess levels of T3 and T4 because of thyroid-stimulating autoantibodies, which bind to and activate thyrotropin receptors within the thyroid gland, causing the gland to enlarge and continually synthesize thyroid hormones. Graves’ disease is the most common cause of hyperthyroidism.

Question 6

Question 6 of 8

The physician states that Janelle may need surgery to remove her thyroid gland. What other endocrine tissues are located near the thyroid glands?
Adrenal glands
Parathyroid glands
Pituitary gland
Pineal gland

Answer 6

Parathyroid glands

The parathyroid glands are small glands, normally four in number, located on the posterior thyroid. Procedures on the thyroid gland may result in incidental parathyroid injury.

Question 7

Question 7 of 8

If the parathyroid gland is damaged during thyroid surgery, which condition will the physician be most concerned about Janelle developing?
Hypernatremia
Hypocalcemia
Hypokalemia
Diuresis

Answer 7

Hypocalcemia

The parathyroid glands release parathyroid hormone in response to low serum calcium. If the parathyroid glands are damaged and cannot release parathyroid hormone, serum calcium levels may fall.

Question 8

Question 8 of 8

The physician informs Janelle that if her thyroid gland was removed, she would need to take medication to replace the hormones normally synthesized by this gland. Which medication will Janelle likely be prescribed?
Naproxen
Amantadine
Herceptin
Levothyroxine

Answer 8

Levothyroxine

Once the thyroid gland is removed, Janelle must take a replacement thyroid hormone such as levothyroxine for the rest of her life. She will work closely with her physician to determine the proper dosage to meet her metabolic needs.

Question 9

Question 1 of 5

Excess antidiuretic hormone is associated with which of the following conditions?

Central diabetes insipidus
Graves’ disease
SIADH
Hashimoto’s thyroiditis

Answer 9

SIADH

Question 10

Question 2 of 5

A patient with central diabetes insipidus _________________.

will drink less water than normal.
will have a higher than normal metabolism.
will likely have edema.
will have increased urine output

Answer 10

will have increased urine outpuT

Question 11

Question 3 of 5

Hyperfunction of the ________________ that results in excess growth hormone may cause ___________.

posterior pituitary; acromegaly
anterior pituitary; acromegaly
hypothalamus; acromegaly
anterior pituitary; Graves’ disease

Answer 11

anterior pituitary; acromegaly

Question 12

Question 4 of 5

The nurse finds decreased T3 and T4 hormone levels in the laboratory report of a patient diagnosed with an endocrine disorder. What specific characteristics does the nurse expect to find? Select all that apply.

Fatigue
Weight loss
Feeling hot
Decreased heart rate
Weight gain

Answer 12

Fatigue
Decreased heart rate
Weight gain

Question 13

Question 5 of 5

The most common cause of thyroid hyperfunction is ______________.

elevated TSH.
Hashimoto’s thyroiditis.
Graves’ disease.
a tumor of the pituitary.

Answer 13

Graves’ disease.