Thyroid Disorders

Question 1

What is the normal TSH level?

Answer 1

0.5-4.5

Question 2

What is the normal free T4 level?

Answer 2

0.8-2.7

Question 3

Which of the following is indicative of hyperthyroid?
A. Increased free T4, increased TSH
B. Increased free T4, decreased TSH
C. Decreased free T4, decreased TSH
D. Decreased free T4, increased TSH

Answer 3

B. Increased free T4, decreased TSH

Question 4

Which of the following is indicative of hypothyroid?
A. Increased free T4, increased TSH
B. Increased free T4, decreased TSH
C. Decreased free T4, decreased TSH
D. Decreased free T4, increased TSH

Answer 4

D. Decreased free T4, increased TSH

Question 5

If a patient has myxedema coma, what 2 medications are used to correct this?

Answer 5

IV T4 bolus thyroxine (can switch to oral once patient is stabilized)
IV hydrocortisone

Question 6

Since the brand and generic forms of levothyroxine can differ by up to 33%, it is important to keep patients on the same levothyroxine product. If it is changed, then recheck TSH levels in ____ weeks.

Answer 6

6-8

Question 7

The normal maintenance dose of levothyroxine is _____.

Answer 7

100-150 micrograms/day

Question 8

If you are dosing levothyroxine for a young healthy patient, what is the starting dose?

Answer 8

Full replacement dose of 1.6 micrograms/kg/day

Question 9

If you are dosing levothyroxine for an elderly patient (> 60) who does not have CHD, what is the starting dose and titration?

Answer 9

Start at 50 micrograms/day, titrate up by 25-50 micrograms as required (Goal is 1 mcg/kg/day).

Question 10

If you are dosing levothyroxine for any patient with CHD, what is the starting dose and titration?

Answer 10

Start 12.5-25 mpg/day, titrate up by 12.5-25 mcg as tolerated.

Question 11

When should you expect clinical improvement with levothyroxine?
A. 1-2 weeks
B. 2-3 weeks
C. 4-6 weeks
D. 6-8 weeks

Answer 11

B. 2-3 weeks

Question 12

When is levothyroxine steady state achieved?
A. 1-2 weeks
B. 2-3 weeks
C. 4-6 weeks
D. 6-8 weeks

Answer 12

D. 6-8 weeks

Question 13

When and how often should you monitor TSH levels when on levothyroxine?
A. 1-2 weeks after starting until euthyroid then every 6-12 months
B. 2-3 weeks after starting until euthyroid then every 6-12 months
C. 4-6 weeks after starting until euthyroid then every 6-12 months
D. 6-8 weeks after starting until euthyroid then every 6-12 months

Answer 13

D. 6-8 weeks after starting until euthyroid then every 6-12 months