ENDOCRINOLOGY BOARDS ABIM EXAM
LATEST VERSION 2025-2025 ACTUAL EXAM
140 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
Painless thyroiditis - ✔ANASWER✔-Can be either hypo or
hyperthyroid
Hyperthyroid first 2-4 wks, then hypothyroid 4-12 wks, then
recover
Exam- diffuse painless goiter
50% go on to have anti-TPO abs and Hashimoto's
,Postpartum thyroiditis - ✔ANASWER✔-10-15% of postpartum
women
Hyper or hypothyroid sxs
ESR nl, many have anti-TPO abs
Radiation thyroiditis - ✔ANASWER✔-Usually occurs 7-10 d after
exposure
Euthyroid sick syndrome - ✔ANASWER✔-Body does not need
much T3, so converts T4 to rT3-> low T3, low/nl TSH, T4; think of
this is ill pt with these labs, not pituitary insufficiency
If need to confirm, check rT3 - high in ESS, low in pituitary insuff.
Thyroid nodule basics - ✔ANASWER✔-5-10% malignant, 95%
cold, 85% of those benign; hot nodules are almost always benign
5% of people with prior neck irradiation get nodules
Hot nodules are never malignant; don't biopsy!
Evaluate all cold nodules, even in Graves, MNG
Don't screen for nodules unless risk factors, but w/u all palpable
nodules
,Risk factors for thyroid nodules - ✔ANASWER✔-Hx head/neck
radiation
FH thyroid cancer
Age<20, >70
Male
Growing nodule, firm or hard
Lymphadenopathy
Fixed nodule
Compression sxs- dysphonia, dysphagia, cough
Thyroid nodule workup - ✔ANASWER✔-Suspicious nodule on US
- do FNA
Non-suspicious nodule: High TSH- think Hashimotos, measure
anti-TPO abs, treat hypothyroidism; Low TSH- do RAIU scan- hot
nodule- no further WU
Do RAUI/ thyroid scan in all MNG to look for cold nodules
What are primary, secondary, and tertiary disease? -
✔ANASWER✔-Primary - problem with the gland that secretes the
hormone (ie: thyroid doesn't produce thyroid hormone)
Secondary - problem is the gland that controls the primary gland
(ie. pituitary doesn't produce TSH to stimulate the thyroid)
, Tertiary - problem with the gland that controls the secondary
gland that controls the primary gland (ie. hypothalamus not
producing TRH ->no TSH from pituitary -> no T3/T4 from thyroid)
How does the hypothalamus control the pituitary? -
✔ANASWER✔-Controls the anterior pituitary via hormones
Controls the posterior pituitary via neurohypophysis - direct nerve
stimulation
Posterior pituitary functions - ✔ANASWER✔-Secrete ADH and
oxytocin
ADH regulation - ✔ANASWER✔-Anterior pituitary -
osmoreceptors to control ADH release and thirst
Increased release rapidly with elevated osmolarity
Also see increased release with nausea
ADH osmolar release set point is affected by:
Lower set point (release at lower osm) with pregnancy and pre-
menses
Higher set point with chronic hypovolemia, acute HTN,
corticosteroids
LATEST VERSION 2025-2025 ACTUAL EXAM
140 QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES
Painless thyroiditis - ✔ANASWER✔-Can be either hypo or
hyperthyroid
Hyperthyroid first 2-4 wks, then hypothyroid 4-12 wks, then
recover
Exam- diffuse painless goiter
50% go on to have anti-TPO abs and Hashimoto's
,Postpartum thyroiditis - ✔ANASWER✔-10-15% of postpartum
women
Hyper or hypothyroid sxs
ESR nl, many have anti-TPO abs
Radiation thyroiditis - ✔ANASWER✔-Usually occurs 7-10 d after
exposure
Euthyroid sick syndrome - ✔ANASWER✔-Body does not need
much T3, so converts T4 to rT3-> low T3, low/nl TSH, T4; think of
this is ill pt with these labs, not pituitary insufficiency
If need to confirm, check rT3 - high in ESS, low in pituitary insuff.
Thyroid nodule basics - ✔ANASWER✔-5-10% malignant, 95%
cold, 85% of those benign; hot nodules are almost always benign
5% of people with prior neck irradiation get nodules
Hot nodules are never malignant; don't biopsy!
Evaluate all cold nodules, even in Graves, MNG
Don't screen for nodules unless risk factors, but w/u all palpable
nodules
,Risk factors for thyroid nodules - ✔ANASWER✔-Hx head/neck
radiation
FH thyroid cancer
Age<20, >70
Male
Growing nodule, firm or hard
Lymphadenopathy
Fixed nodule
Compression sxs- dysphonia, dysphagia, cough
Thyroid nodule workup - ✔ANASWER✔-Suspicious nodule on US
- do FNA
Non-suspicious nodule: High TSH- think Hashimotos, measure
anti-TPO abs, treat hypothyroidism; Low TSH- do RAIU scan- hot
nodule- no further WU
Do RAUI/ thyroid scan in all MNG to look for cold nodules
What are primary, secondary, and tertiary disease? -
✔ANASWER✔-Primary - problem with the gland that secretes the
hormone (ie: thyroid doesn't produce thyroid hormone)
Secondary - problem is the gland that controls the primary gland
(ie. pituitary doesn't produce TSH to stimulate the thyroid)
, Tertiary - problem with the gland that controls the secondary
gland that controls the primary gland (ie. hypothalamus not
producing TRH ->no TSH from pituitary -> no T3/T4 from thyroid)
How does the hypothalamus control the pituitary? -
✔ANASWER✔-Controls the anterior pituitary via hormones
Controls the posterior pituitary via neurohypophysis - direct nerve
stimulation
Posterior pituitary functions - ✔ANASWER✔-Secrete ADH and
oxytocin
ADH regulation - ✔ANASWER✔-Anterior pituitary -
osmoreceptors to control ADH release and thirst
Increased release rapidly with elevated osmolarity
Also see increased release with nausea
ADH osmolar release set point is affected by:
Lower set point (release at lower osm) with pregnancy and pre-
menses
Higher set point with chronic hypovolemia, acute HTN,
corticosteroids
