NR565 Week 5: Endocrine System Case
Study – Helen Smith, Alfonso Giuliani,
John Jones (Answered) 100 out of 100
Points (Latest 2026)
Helen Smith: Hypothyroidism
1. Helen Smith is a 45-year-old female presenting with fatigue, weight gain,
cold intolerance, and dry skin. Her lab results show an elevated TSH and a
low Free T4. What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary Hypothyroidism
C. Secondary Hypothyroidism
D. Thyroiditis
Answer: B
2. What is the drug of choice for treating Helen's newly diagnosed primary
hypothyroidism?
A. Liothyronine (Cytomel)
,B. Levothyroxine (Synthroid)
C. Methimazole (Tapazole)
D. Propylthiouracil
Answer: B
3. When initiating levothyroxine therapy for Helen, what is the appropriate
starting dose for a healthy adult?
A. 25-50 mcg daily
B. 1.6 mcg/kg of ideal body weight
C. 100-125 mcg daily
D. Both A and B are correct.
Answer: D
4. How should Helen take her levothyroxine medication for optimal
absorption?
A. With breakfast
B. At bedtime
C. On an empty stomach, 30-60 minutes before breakfast
D. With a high-fiber meal
Answer: C
,5. After starting levothyroxine, how long should you wait before checking
Helen's TSH to assess the therapy's effectiveness?
A. 1-2 weeks
B. 2-4 weeks
C. 6-8 weeks
D. 3 months
Answer: C
6. Helen's TSH goal on levothyroxine replacement therapy is:
A. Undetectable
B. 0.5-2.5 mIU/L
C. 5-10 mIU/L
D. Whatever level resolves her symptoms
Answer: B
7. Which of the following medications can significantly decrease the
absorption of levothyroxine?
A. Calcium Carbonate
B. Iron Sulfate
C. Proton Pump Inhibitors (e.g., Omeprazole)
D. All of the above
Answer: D
, 8. If Helen were 80 years old with a history of coronary artery disease, what
would be a prudent initial dose of levothyroxine?
A. 125 mcg daily
B. 25 mcg daily
C. 1.6 mcg/kg daily
D. 200 mcg daily
Answer: B
9. A patient with subclinical hypothyroidism (elevated TSH, normal T4)
should always be treated with levothyroxine.
A. True
B. False
Answer: B
10. Helen asks if she can use a natural desiccated thyroid (NDT) product like
Armour Thyroid instead of levothyroxine. The best response includes that:
A. NDT is the preferred first-line treatment.
B. NDT is not recommended as first-line due to the risk of variable hormone levels
and cardiac effects.
C. NDT is more potent and has fewer side effects.
D. NDT is cheaper and always covered by insurance.
Answer: B
Study – Helen Smith, Alfonso Giuliani,
John Jones (Answered) 100 out of 100
Points (Latest 2026)
Helen Smith: Hypothyroidism
1. Helen Smith is a 45-year-old female presenting with fatigue, weight gain,
cold intolerance, and dry skin. Her lab results show an elevated TSH and a
low Free T4. What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary Hypothyroidism
C. Secondary Hypothyroidism
D. Thyroiditis
Answer: B
2. What is the drug of choice for treating Helen's newly diagnosed primary
hypothyroidism?
A. Liothyronine (Cytomel)
,B. Levothyroxine (Synthroid)
C. Methimazole (Tapazole)
D. Propylthiouracil
Answer: B
3. When initiating levothyroxine therapy for Helen, what is the appropriate
starting dose for a healthy adult?
A. 25-50 mcg daily
B. 1.6 mcg/kg of ideal body weight
C. 100-125 mcg daily
D. Both A and B are correct.
Answer: D
4. How should Helen take her levothyroxine medication for optimal
absorption?
A. With breakfast
B. At bedtime
C. On an empty stomach, 30-60 minutes before breakfast
D. With a high-fiber meal
Answer: C
,5. After starting levothyroxine, how long should you wait before checking
Helen's TSH to assess the therapy's effectiveness?
A. 1-2 weeks
B. 2-4 weeks
C. 6-8 weeks
D. 3 months
Answer: C
6. Helen's TSH goal on levothyroxine replacement therapy is:
A. Undetectable
B. 0.5-2.5 mIU/L
C. 5-10 mIU/L
D. Whatever level resolves her symptoms
Answer: B
7. Which of the following medications can significantly decrease the
absorption of levothyroxine?
A. Calcium Carbonate
B. Iron Sulfate
C. Proton Pump Inhibitors (e.g., Omeprazole)
D. All of the above
Answer: D
, 8. If Helen were 80 years old with a history of coronary artery disease, what
would be a prudent initial dose of levothyroxine?
A. 125 mcg daily
B. 25 mcg daily
C. 1.6 mcg/kg daily
D. 200 mcg daily
Answer: B
9. A patient with subclinical hypothyroidism (elevated TSH, normal T4)
should always be treated with levothyroxine.
A. True
B. False
Answer: B
10. Helen asks if she can use a natural desiccated thyroid (NDT) product like
Armour Thyroid instead of levothyroxine. The best response includes that:
A. NDT is the preferred first-line treatment.
B. NDT is not recommended as first-line due to the risk of variable hormone levels
and cardiac effects.
C. NDT is more potent and has fewer side effects.
D. NDT is cheaper and always covered by insurance.
Answer: B
