NURP 533 Exam 1 Questions With Complete Solutions
hypothyroid diaagnostics
TSH
Free T4
Thyroid peroxidase antibodies (TPO)
antithyroglobulin antibodies
when will thyroid peroxidase antibody test be positive?
chronic autoimmune thyroiditis
High TSH, Low T4
primary hypothyroidism
High TSH, normal T4
subclinical hypothyroidism
normal TSH, low T4
secondary hypothyroid (pituitary or hypothalamus)
severe nonthyroidal illness
if elevated TSH and normal T4, if TSH is 5-10 and patient is
symptomatic...
3-6 month trial of levothyroxine and continue if there is a
benefit
if elevated TSH (5-10) and asymptomatic, check TPO and...
if positive, levothyroxine or annual thyroid testing
if negative, thyroid function testing every 3 years
,If TSH elevated to >10 and T4 normal...
treat with levothyroxine
average levothyroxine dose
1.6 mcg/kg/day
who needs a lower dose of levothyroxine
CAD
old age
levothyroxine admin instructions
do not take with vitamins- space out by at least 4 hours
take on an empty stomach in the AM
TSH level first trimester pregnancy
keep less than 2.5
TSH level 2nd and 3rd trimester pregnancy
keep less than 2
levothyroxine dose requirement in pregnancy
20-30% higher
hypothyroid: when to refer
infants and children
unresponsive to therapy
pregnancy
cardiac patients
nodule or structural problem
, presence of other endocrine disease
unusual constellation of thyroid test results
subacute thyroiditis
Acute, painful, glandular enlargement with dysphagia. Gland is
woody, hard, tender
Tx: ASA and NSAIDs, beta blockers
labs subacute thyroiditis
low TSH and high T4 for a few weeks, then hypothyroid, then
euthyroid
labs postpartum thyroiditis
thyrotoxic briefly
transition to hypothyroid for 3-6 months
then euthyroid
hyperthyroid signs and symptoms
palpitations, tachycardia, A-fib
anxiety, tremor, jitteriness
diaphoresis
heat intolerance
exophthalmos
weight loss
insomnia
hyperthyroid exam findings
palpable goiter
bulging eyes 'pretibial myxedema
orange peel appearance lower extremities
hypothyroid diaagnostics
TSH
Free T4
Thyroid peroxidase antibodies (TPO)
antithyroglobulin antibodies
when will thyroid peroxidase antibody test be positive?
chronic autoimmune thyroiditis
High TSH, Low T4
primary hypothyroidism
High TSH, normal T4
subclinical hypothyroidism
normal TSH, low T4
secondary hypothyroid (pituitary or hypothalamus)
severe nonthyroidal illness
if elevated TSH and normal T4, if TSH is 5-10 and patient is
symptomatic...
3-6 month trial of levothyroxine and continue if there is a
benefit
if elevated TSH (5-10) and asymptomatic, check TPO and...
if positive, levothyroxine or annual thyroid testing
if negative, thyroid function testing every 3 years
,If TSH elevated to >10 and T4 normal...
treat with levothyroxine
average levothyroxine dose
1.6 mcg/kg/day
who needs a lower dose of levothyroxine
CAD
old age
levothyroxine admin instructions
do not take with vitamins- space out by at least 4 hours
take on an empty stomach in the AM
TSH level first trimester pregnancy
keep less than 2.5
TSH level 2nd and 3rd trimester pregnancy
keep less than 2
levothyroxine dose requirement in pregnancy
20-30% higher
hypothyroid: when to refer
infants and children
unresponsive to therapy
pregnancy
cardiac patients
nodule or structural problem
, presence of other endocrine disease
unusual constellation of thyroid test results
subacute thyroiditis
Acute, painful, glandular enlargement with dysphagia. Gland is
woody, hard, tender
Tx: ASA and NSAIDs, beta blockers
labs subacute thyroiditis
low TSH and high T4 for a few weeks, then hypothyroid, then
euthyroid
labs postpartum thyroiditis
thyrotoxic briefly
transition to hypothyroid for 3-6 months
then euthyroid
hyperthyroid signs and symptoms
palpitations, tachycardia, A-fib
anxiety, tremor, jitteriness
diaphoresis
heat intolerance
exophthalmos
weight loss
insomnia
hyperthyroid exam findings
palpable goiter
bulging eyes 'pretibial myxedema
orange peel appearance lower extremities
