Thyroid hormones and Anti Thyroid Hormones

Question 1

TSH is a

Answer 1

Glycoprotein

Question 2

How many alpha and beta subunits does TSH have?

Answer 2

6- alpha and 1-beta

Question 3

The beta subunit of TSH is what gives it its

Answer 3

Specific functionality

Question 4

what is thyrotropin alpha?

Answer 4

It is a recombinant form of TSH used in performing certain tests in patients who have or have had thyroid cancer

Question 5

Thyrotropin alpha is used for?

Answer 5

Used along with a radioactive agent to destroy remaining thyroid tissue in certain patients who have had their thyroid gland removed because of thyroid cancer

Question 6

What is the MOA of thyrotropin alpha?

Answer 6

Binds to the thyrotropin receptors found on any residual thyroid cells or tissues. This stimulates radioactive iodine uptake for better radiodaignostic imaging

Question 7

During fetal development, TSH affects the

Answer 7

Brain

Question 8

TSH induces growth, development, maturation of

Answer 8

Sperms and oocytes

Question 9

TSH induces growth, development, maturation of

Answer 9

Osteoblasts and osteocytes

Question 10

TSH induces the growth, development, and differentiation of adipose tissue in which places?

Answer 10

Retroocular, pretibial, abdominocentral

Question 11

In the kidneys, TSH is going to induce the growth, development and maturation of the

Answer 11

Epithelial cells

Question 12

TSH induces the growth, maturation and differentiation of

Answer 12

Immune cells

Question 13

TSH plays a role in the maturation of the

Answer 13

Embryo

Question 14

The TSH receptor is a..

Answer 14

7 transmembrane receptor embedded within the plasma membrane and a short cytoplasmic tail

Question 15

Which two TSHR activation pathways exist?

Answer 15

AC activation by Gs

PLC activation by Gq

Question 16

The sodium/iodide symporter belongs to which human transport family?

Answer 16

SLC5

Question 17

Where is the sodium/iodide symporter expressed?

Answer 17

Salivary gland ductal cells, breast tissue during lactation, lung airway epithelial cells, intestinal enterocytes, epithelial and parietal stomach cells, placenta and testicular cells

Question 18

Pendred syndrome is characterized by?

Answer 18

Goiter and hearing loss

Autosomal recessive disorder

Question 19

Pendrine is a

Answer 19

SLC26 transporter

Question 20

Thyroglobulin is a

Answer 20

Glycoprotein composed of two subunits

Question 21

Which protein has the higher affinity towards T3 and T4?

Answer 21

Thyroxine-binding globulin

Question 22

Which protein is the larger transporter of thyroid hormone?

Answer 22

Albumin

Question 23

What molecule is needed to activate the receptor and induce gene expression?

Answer 23

T3

Question 24

What is the best treatment for hypothyroidism?

Answer 24

L-T4

Question 25

Thyroid hormone replacement must occur on a

Answer 25

Empty stomach | - with no other medications or foods beyond water ideally consumed for at least 1 hour after ingestion

Question 26

Repeated thyrotropin measurement should be performed in approximately how many weeks?

Answer 26

6

Question 27

Do proton pump inhibitors affect the absorption of L-T4?

Answer 27

No

Question 28

Does cholestyramine affect the absorption of L-T4?

Answer 28

Yes, best absorption with a 5 hour separation of drug and L-T4

Question 29

Do H2 blockers affect the absorption of L-T4?

Answer 29

No

Question 30

Does colesevelam negatively affect the absorption of levothyroxine?

Answer 30

Yes

Question 31

Does selevamer affect the absorption of levothyroxine?

Answer 31

Yes

Question 32

Does sucralfate affect the absorption of levothyroxine?

Answer 32

Yes reduced and delayed peak absorption

Question 33

Does raloxifene affect the absorption of levothyroxine?

Answer 33

Yes, lower peak T4 levels with raloxifene

Question 34

Does calcium carbonate affect the absorption of levothyroxine?

Answer 34

Yes

Question 35

Do the proton pump inhibitors alter the interaction of the levothyroxine with their receptors?

Answer 35

Yes

Question 36

Hyperthyroidism treatment should be divided into

Answer 36

Symptomatic and target treatment

Question 37

What medication is given for the symptomatic treatment of hyperthyroidism?

Answer 37

Beta blockers

Question 38

Patients with overt Grave’s disease should be treated with

Answer 38

RAI therapy, ATD’s or thyroidectomy RAI- radioactive iodine therapy ATD- anti thyroid drugs

Question 39

What is the first line treatment for the symptomatic managment of hyperthyroidism?

Answer 39

Beta blockers such as propanolol, atenolol, metoprolol, nadolol, esmolol

Question 40

If a patient with hyperthyroidism is experiencing cardiovascular symptoms, what medication would be most appropriate?

Answer 40

Atenolol

Question 41

In a patient with thyrotoxicosis, propanolol or nadolol would be better for a patient with

Answer 41

Central nervous system symptoms

Question 42

What other drug can be given in a patient with thyrotoxicosis who has cardiovascular symptoms?

Answer 42

Metoprolol

Question 43

Lets say you have a patient with thyrotoxicosis who is nursing or is pregnant, which drug would you give them? (You have to choose a beta blocker)

Answer 43

Propanolol

Question 44

If you have a pregnant patient with thyrotoxicosis which beta blocker should you avoid?

Answer 44

Atenolol

Question 45

Lets say you have a patient with thyrotoxicosis who is in the ICU which beta blocker would you give them?

Answer 45

Esmolol

Question 46

Can you use radio active iodine therapy in a pregnant patient?

Answer 46

No

Question 47

If you have a patient with hyperthyroidism who is seeking RAI therapy under what circumstances should you not perform this type of therapy?

Answer 47

Pregnancy, lactation, thyroid cancer, suspision of thyroid cancer, planning pregnancy in 4-6 months

Question 48

Under what circumstances should you not give a patient with hyperthyroidism ATD’s?

Answer 48

If they have any adverse reactions to them

Question 49

If you have a patient with hyperthyroidism who is seeking surgery, under what circumstances should you not perform surgery?

Answer 49

Cardiopulmonary disease, end-stage cancer, avoid surgery in the first and third trimester of pregnancy

Question 50

What drugs are used to treat thyroid storm?

Answer 50

Propylthiouracil, methimazole, propanolol, iodine, hydrocortisone

Question 51

Propylthiouracil blocks what?

Answer 51

New hormone synthesis

Question 52

what does methimazole do?

Answer 52

Blocks T4 to T3 conversion | Blocks new hormone synthesis

Question 53

Which drug may block T4-T3 conversion in high doses?

Answer 53

Propanolol

Question 54

Which drug should not be started until 1 hour after antithyroid drugs?

Answer 54

Iodine (saturated solution of potassium iodide)

Question 55

Methimazole is good for which types of patients?

Answer 55

Those for whom more aggressive options such as surgery or radioactive iodine therapy is innappropriate

Question 56

Propylthiouracil is the active metabolite of which pro-drug?

Answer 56

Carbimazole

Question 57

Methimazole inhibits

Answer 57

Thyroid peroxidase

Question 58

Methimazole becomes what?

Answer 58

Iodinated itself and interferes with the iodination of thyroglobulin

Question 59

Methimazole binds directly to ?

Answer 59

Thyroglobulin or direct inhibition of thyroglobulin itself

Question 60

Should propylthiouracil be used in the pediatric population?

Answer 60

No

Question 61

Should PTU be used in patients with liver impairment?

Answer 61

No

Question 62

PTU can cause fetal what?

Answer 62

Cretinism and goiter

Question 63

Methimazole causes

Answer 63

Fetal anatomical abnormalities

Question 64

If you have a patient with subclinical hyperthyroidism and he or she had a TSH of less than 0.1 mU/L do you treat them?

Answer 64

Yes

Question 65

If a patient is pregnant and she has Grave’s disease, when is the ideal time to peform a thyroidectomy?

Answer 65

Second trimester