thyroid 2

Question 1

TSH goal for Treatment monitoring

Answer 1

0.5-4

Question 2

amount to increase levothyroxine by

Answer 2

12.5-25mcg

Question 3

If tsh remains between .5-2 you may monitor at 6 months then?

Answer 3

annually

Question 4

Steps to take after identifying a thyroid nodule?

Answer 4

obtain tsh and ultrasound, then refer for fine needle biopsy

Question 5

Is hypercalcemia caused by excess PTH

Answer 5

yes

Question 6

Clinical presentation of hyperparathyroidism

Answer 6

moans, groans, stones, and bones

tired, depression, osteoporosis, kidney stones, arrhythmias

Question 7

You see a 38-year-old woman with hypothyroidism who is currently taking levothyroxine 75 mcg/d with excellent adherence, stating, “I take the medicine every morning on an empty stomach with a big glass of water.” She is feeling well. Results of today’s laboratory testing includes a TSH=4.5 mIU/mL. The next best step in her care is to:

Continue on the same levothyroxine dose and obtain a repeat TSH in 1 year.
Decrease the levothyroxine dose by 25 mcg/d and repeat a TSH in 1 month.
Increase the levothyroxine dose by 25 mcg/d and repeat a TSH in 2 months.
Repeat TSH today and provide counseling to take the medication with breakfast.

Answer 7

Increase the levothyroxine dose by 25 mcg/d and repeat a TSH in 2 months.

Question 8

Mrs. Lange is a 79-year-old woman with a >20-year history of well-controlled hypertension and dyslipidemia, currently taking an ACE inhibitor, low-dose thiazide diuretic, and a statin. She presents today with a chief complaint of a 6-month history of progressive symptoms, including fatigue, difficulty initiating and maintaining sleep, increased difficulty with raising her arms above her head, and a sensation of “my heart not beating right, sometimes I feel like it’s going to hop right out of my chest.” She denies shortness of breath, chest pain, cough, or difficulty breathing when supine and admits to “losing weight without even trying.” Cardiac examination reveals an irregularly irregular cardiac rhythm, without S3, S4, or murmur and no neck vein distention. Electrocardiogram is as shown.
The remainder of Mrs. Lange’s physical examination reveals flat affect, fine tremor, 3–4+ DTR response, mild proximal muscle weakness, symmetric thyroid enlargement without tenderness or mass and a 10-lb (4.5-kg) weight loss since her last visit 8 months ago. The remainder of Mrs. Lange’s examination is at her baseline. Which of the following is the most likely diagnosis?

Thyrotoxicosis
Statin-induced myopathy
Heart failure
Hypothyroidism

Answer 8

thyrotoxicosis

Question 9

Choose the two most important tests to help support Mrs. Lange’s diagnosis.

Serum creatine kinase
Serum electrolytes
Serum thyroid stimulating hormone
B-type natriuretic peptide
Free thyroxine (FT4)

Answer 9

TSH and Free t4

Question 10

One of the most common causes of asymptomatic hypercalcemia in an otherwise well adult is:

Excessive use of calcium supplements.
Primary hyperparathyroidism.
Renal insufficiency.
Intestinal malabsorption

Answer 10

Primary hyperparathyroidism