Review Diseases of the

Thyroid Gland
• A 60-year-old woman presents with complaints of feeling nervous,
moody, weak, and tired. On exam, she has hand tremors and a rapid
heartbeat. Pulse 120/min. BP 110/78. She has been taking
levothyroxine for hypothyroidism, and you suspect that she is taking
more tablets than you prescribed. Which of the following sets of
laboratory results is most consistent with her clinical presentation?
• A B C D E
• TSH Elevated Normal Elevated Normal Decreased
• T4 Elevated Elevated Decreased Decreased Elevated
• T3 Elevated Decreased Decreased Decreased Elevated
• 50 year old man presents with a thyroid neoplasm. Detailed history elicits that his aunt
had died from a "thyroid illness". His family and first order blood relatives are examined.
His sister and a nephew also are found to have small thyroid tumors. His son is found to
have a pheochromocytoma. Which of the following gene mutations are most likely to be
associated with this condition?

• PTTG

• Cyclin D

• Ret

• MEN 1

• TBG
• A 34 year old man reports to your office complaining of weight loss
and sweating. Among other findings you note the following, while
examining his extraocular movements: What do we call this finding?

• Proptosis

• Ophthalmoplegia

• Lid lag

• Trochlear nerve palsy

• Levator palpebrae dysfunctio

• A 44-year-old African American man presents to his family physician
with a neck lump he noticed while shaving this morning. Physical
examination reveals a 1 cm well-defined firm nodule in the right
thyroid lobe. The mass is resected and sent for histopathologic
examination. The microscopic appearance of the lesion is shown for
your evaluation below. Elevation of which of the following serum
markers can you expect in this patient?
• Thyroid stimulating hormone
• Calcitonin
• Thyroglobulin
• Carcinoembryonic antigen
• A 43-year-old Caucasian man presents to his family physician with a neck
lump he noticed while shaving this morning. Physical examination reveals a
0.5 cm ill-defined firm nodule in the left thyroid lobe. Laboratory
investigations reveal an elevated serum level of carcinoembryonic antigen,
serotonin, parathormone, and calcitonin. 99mTechnetium thyroid scan and
fine needle aspiration biopsy of the nodule is performed and the patient
undergoes thyroidectomy. The thyroid scan and histology of the lesion are
presented for your evaluation. Which of the following clinical syndromes is
most likely to be found in this patient?

• Acromegaly

• Diabetes insipidus

• Severe hypertension
• Myxedema
• Individuals with hypothyroidism would mostly likely have which one of the
following conditions?

• Growth retardation if occurs during the perinatal period

• Increased cardiac output

• Weight loss

• Excessive production of TSH if the defect is in the hypothalamus

• Less than normal levels of cholesterol in the circulation

• Iodine deficiency used to be a common cause of thyroid enlargement (goiter) in some parts of the
world. Which abnormality in chronically iodine-deficient patients is most directly related to the
enlargement of the thyroid gland?

• Reduced activity of thyroperoxidase

• Impaired conversion of T4 to T3

• Reduced level of cAMP in the thyroid follicular cells

• An antibody that binds to the TSH receptor in the thyroid gland

• Elevated TSH level

• Which of the following effects may be caused high plasma levels of thyroid hormones?
(Check all that apply)

• Decreased cardiac output

• Increased gluconeogenesis

• Decreased plasma levels of triglycerides

• Decreased plasma levels of free fatty acids

• Increased pulse pressure

• Decreased intestinal peristalsis

•
• Which of the following effects may be caused by insufficient plasma levels of thyroid hormones?
(Check all that apply)

• Oligospermia

• Decreased respiratory rate

• Decreased plasma triglycerides

• Decreased peripheral vascular resistance

• Osteoporosis

• Periorbital edema

• Diarrhea
•
• A 42-year-old man was undergoing surgery in order to remove a very large
nontoxic goiter, apparently due to iodide deficiency. A short course of
potassium iodide was administered before surgery. Which of the following
statements best explains why this drug was given to the patient?

• To stimulate thyroid hormone synthesis before surgery

• To overcome iodine deficiency after surgery

• To reduce the size and vascularity of the thyroid gland

• To decrease the risk of hypothyroidism after surgery

• To inhibit the excessive secretion of TSH from the pituitary

• A 55-year-old woman with thyrotoxicosis was treated with radioactive
iodine. One month later she most likely started a therapy with which of the
following drugs?

• Potassium iodide

• Levothyroxine

• Diiodotyrosine

• Monoiodotyrosine

• Reverse triiodothyronine
• A 59-year-old woman was admitted to the hospital with restlessness, insomnia,
tremor and a pronounced exophthalmos. The woman, who had been suffering
from hyperthyroidism for two months, had been treated with propylthiouracil but
the drug was discontinued because of the appearance of agranulocytosis. Which
of the following agents would be most appropriate for the patient at this time?

• Methimazole

• Radioactive iodine

• Potassium iodide

• Propranolol

• Prednisone
• A 55-year old woman recently diagnosed with hyperthyroidism started an
appropriate treatment. One month later the following laboratory values
were obtained: RBC 4.6 x 10 /mcl, WBC 0.9 x 10 /mcl, platelets 45 6 3 x
103/mcl. Which of the following drugs most likely causes these results?

• Radioactive iodine

• Potassium iodide

• Methimazole

• Propranolol

• L-thyroxine
• Few days after a normal delivery, a new born baby boy became lethargic, had respiratory
difficulties, hoarse cry, and sucks poorly. Physical examination revealed large fontanelles,
macroglossia, a distended abdomen, a cyanotic skin, hypotonia, slow reflexes and
hypothermia. Which of the following drugs would be appropriate for this baby?

• Methimazole

• Somatrem

• Levothyroxine

• Theophylline

• Potassium iodide

• Prednisone
• A 35 year old woman, who was 2 months pregnant, was found to have FT4
of 3.3 ng/dL (normal 0.9-2) and TSH < 0.01 IU/mL (normal 0.5-4.7) during a
follow up visit. Which of the following chronic drug treatment would be
most appropriate for this patient?

• Radioactive iodine

• Propranolol

• Potassium iodide

• Ipodate

• Propylthiouracil
• A 75-year-old woman came to the clinic for her regular checkup. Her only complaints included
very dry skin and constipation which she treats with milk of magnesia. She had no other medical
problems and took no other medications. Routine laboratory tests are within normal limits except
for a TSH of 15 mIU/mL (normal 0.5-5.5). Further lab exams indicated the presence of thyroid
peroxidase antibodies. Which of the following drug would be appropriate for this patient?

• Potassium iodide

• Propranolol

• Methimazole

• Loperamide

• Levothyroxine

• Diltiazem
• A 41-year-old man complained to his physician of increased appetite,
palpitation and diarrhea. Lab results confirmed the diagnosis of mild
hyperthyroidism and a treatment with methimazole was started. Which of
the following actions most likely mediated the therapeutic effectiveness of
the drug in this patient?

• Inhibition of iodine absorption from the gut

• Stimulation of thyroid peroxidase

• Blockade of iodine uptake by the thyroid gland

• Damage of DNA of thyroid cells

• Inhibition of tyrosine iodination

• A 47-year-old woman complained to her physician of painless enlargement
of thyroid gland and fullness in her throat. Lab results revealed high titers
of thyroid peroxidase antibodies. A diagnosis of Hashimoto's thyroiditis
was made and an appropriate treatment was started. Which of the
following drugs was most likely prescribed?

• Propranolol

• Potassium iodide

• Levothyroxine

• Methimazole

• Radioactive iodine
• Which of the following drugs can block most effectively the conversion of
T4 to T3 by the liver?

• Levothyroxine

• Diiodotyrosine

• Methimazole

• Propylthiouracil

• TSH
• TSH 8 (0.40-4.0), Free T4 1.0 (0.8-1.9), Free T3 normal.

• 40 year old male with constipation and cold intolerance.

• 35 year old female who is well.

• 25 year old female G2 P1 GA 20/40

• 50 year old male who repeated TFTS 3 months later, TSH 10, normal
Free T4 and Free T3.