Board Review Questions of the Week – Thyroid Disorders

Adam WandermanPersonal Education, Question of the Week

Free thyroid disorder board review questions sample from Med-Challenger.

Thyroid disorder clinical knowledge is an essential component of complete patient care. Med-Challenger offers thyroid disorders review and other endocrinology review questions along with everything else you need to maintain your clinical practice. More free endocrinology, diabetes, and metabolism sample questions can be accessed via this week’s Quick Quiz, and via free trial of the following specialty courses:

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This week’s case-based question:


A 55-year-old woman is admitted to the hospital for hypotension and a hemoglobin level of 5.5 mg/dL due to an actively bleeding duodenal ulcer. She undergoes transfusion and endoscopic treatment and is observed in the intensive care unit on an intravenous infusion of a proton pump inhibitor.

On hospitalization day 2, her laboratory studies show a thyroid-stimulating hormone (TSH) level of 8.5 mIU/L (normal range, 0.4-4.2 mIU/L) and a free thyroxine level of 0.4 ng/dL (normal range, 0.8-2.4 ng/dL).

What is the most appropriate management of her thyroid dysfunction?

Answer Options

oral levothyroxine 50 µg daily
intravenous levothyroxine 100 µg daily
rechecking thyroid studies as an outpatient
checking thyroid peroxidase antibodies
intravenous levothyroxine 100 µg daily plus intravenous hydrocortisone 100 mg every 8 hours

And the answer is …


Correct Answer:

rechecking thyroid studies as an outpatient

Educational Objective:

Discuss situations associated with unreliable thyroid studies.

Key Point:

Thyroid studies are unreliable in acute illness. In the absence of signs and symptoms of hypothyroidism, patients with an elevated TSH level who are acutely ill should be followed-up on an outpatient basis for repeat thyroid studies.

Explanation:

The most appropriate management of her thyroid dysfunction is to recheck her thyroid studies on an outpatient basis.

Thyroid studies are unreliable in acute illness. Most hospitalized patients with a TSH level lower than 10 mIU/L will not have thyroid dysfunction on repeat testing. In the hospital, thyroid studies should only be performed in the setting of highly suggestive symptoms. By contrast, a TSH level higher than 20 mIU/L is strongly suggestive of thyroid dysfunction, even in the setting of acute illness.

Thyroid peroxidase antibodies can predict progression of subclinical hypothyroidism to overt hypothyroidism; their use should be reserved for asymptomatic outpatients.

References:

Manzullo EF, Ross DS. Thyroid function in nonthyroidal illness. Revised June 21, 2017. Accessed April 17, 2018.

Wilkinson I. Oxford Handbook of Clinical Medicine. 2017:220-221.

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