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NURP-533-Week 2 Exam With Complete Solution
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NURP-533-Week 2 Exam WithComplete Solution
Hypothyroidism - Answer High TSH + low T4 = primary hypothyroidism
High TSH + normal T4 = subclinical hypothyroidism
Normal TSH + low T4 = secondary hypothyroidism or severe non-thyroidal illness
Subclinical Hypothyroidism Management - Answer TSH level 5-10 with sx of
hypothyroidism: 3-6 month trial of levothyroxine
TSH level 5-10 without sx of hypothyroidism: shared decision making on whether to treat
or not
TSH> 10: treat with levothyroxine therapy
Levothyroxine (1st line therapy) - Answer Average dose is 1.6 mcg/kg/day
Low dose in patients with CAD or older age
Recheck TSH in 6-8 weeks and adjust as needed
Must take vitamins 4 hours before or after taking levothyroxine
Hypothyroidsim & Pregnancy - Answer 1st Trimester TSH Goal Level: 0.5-2.5
2nd and 3rd Trimester TSH Goal Level: < 3
Dose will need to be increased by 20-30%
After delivery, the dose can be decreased to the pre-pregnancy dose and TSH needs to
be checked 6 weeks later
Subacute Thyroiditis - Answer Exquisitely tender, diffusely enlarged gland after a viral
illness
Tx includes NSAIDS to relieve discomfort
Postpartum Thyroiditis - Answer Inflammation of the thyroid gland following childbirth
Normally occurs 3 months after birth
Painless
Graves Disease - Answer An autoimmune disorder that is caused by hyperthyroidism
and is characterized by goiter and/or exophthalmos
, May hear a bruit in the thyroid upon auscultation
Work-up: supressed TSH, elevated free T3 and T4, elevated total T3, positive thyrotropin
receptor antibody; order CBC, LFTs, and ESR
Tx: methimazole, propythiouricil, radioactive iodine therapy, thyroidectomy,
beta-blockers
Check TSH q2-8 weeks until normal
Toxic Multinodular Goiter - Answer Hyperthyroidism caused by multiple thyroid nodules
Thyroid Storm - Answer Increased temp, pulse, edema, irregular HR, and HTN
Medical emergency
Knowledge Check - Answer Beta blockers should be initiated for patients with Graves'
disease to alleviate the alpha-adrenergic symptoms of the hyperthyroidism. Radioiodine
therapy is used for patients with Graves' ophthalmopathy. Surgical resection is
performed for pregnant women who cannot be managed with thioamides or for patients
who refuse radioiodine therapy. Thioamide therapy is recommended for patients
younger than 20 years old, pregnant women, those with a high likelihood of remission,
and those with active Graves' Orbitopathy
Thyroid Nodule - Answer 1. Check TSH
2. Iodine uptake scan (high)
2(a). Thyroid US
3. Nodule > 1 cm: fine needle aspiration
Management of Benign Thyroid Nodules - Answer Repeat exam,US, and TSH in 12
months and if unchanged, repeat in 24 months
Surgery if > 4 cm or symptomatic
Hyperparathyroidism - Answer Hypersecretion of the parathyroid glands, usually
caused by a tumor which increases calcium levels
If calcium level is increased, repeat it
Bone density scan should be completed
Cushing Disease - Answer Excessive anterior pituitary secretion of ACTH which
produces excess cortisol
Most common cause is due to exogenous steroids
Dx (one of the following): 24-hour urine free cortisol two times, *late night salivary
cortisol two times*, or low-dose dexamethasone suppression test
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