Presentation Symptoms/Physical Exam Hypothyroidism Hyperthyroidism Cold intolerance (↓ heat production) Heat intolerance (↑ heat production) Weight gain ↓ appetite Weight loss ↑ appetite Hypoactivityl Lethargy Fatigue Weakness Hyperactivity Constipation Diarrhea ↓ reflexes ↑ reflexes Bradycardia Tachycardia, palpitations, arrhythmias Dry, cool skin Coarse, brittle hair Warm, moist skin Fine hair Diastolic hypertension (Na/H2O retention) Systolic hypertension Myxedema (facial/periorbital) Osteoporosis Evaluation Labs Hypothyroidism Hyperthyroidism ↑ TSH (best first test) ↓ TSH (best first test) ↓ total T4 ↑ total T4 ↓ free T4 ↑ free T4 Hyper cholesterolemia (↓ LDL receptor synthesis) Hypo cholesterolemia (↑ LDL receptor synthesis) Elevated serum creatine kinase - Treatment Treatment Hypothyroidism Hyperthyroidism Levothyroxine Thionamides Ablative 131I therapy
QUESTIONS 1 of 6 1 2 3 4 5 6 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.15.75) A 34-year-old female presents to her primary care physician complaining of fatigue. Over the last three months she has experienced decreased energy and gained 7 pounds. Review of systems is negative for symptoms of depression but is positive for constipation, myalgias, and cold intolerance. Physical exam is notable for delayed deep tendon reflex relaxation. Vital signs are as follows: T 37.1 C, HR 61, BP 132/88, RR 16, and SpO2 100%. Which of the following is the best initial screening test for this patient? Tested Concept QID: 106821 Type & Select Correct Answer 1 Level of anti-thyroid peroxidase (TPO) antibodies 3% (1/35) 2 Morning cortisol and plasma ACTH 3% (1/35) 3 Serum Free T4 20% (7/35) 4 Serum TSH 74% (26/35) 5 Hemoglobin and hematocrit 0% (0/35) M 2 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept (M1.EC.13.69) A 58-year-old Caucasian female presents to her primary care physician with concerns about several recent health changes. The patient has recently gained weight and can't seem to exercise like she used to. She also notes that her thinking seems slow. Physical examination shows thickened, dry skin. Serum analysis confirms the physician's suspicions. Which of the following findings was most helpful in the diagnosis? Tested Concept QID: 100370 Type & Select Correct Answer 1 High T4 and T3 12% (3/25) 2 Low T4 and T3 56% (14/25) 3 High TSH 24% (6/25) 4 Hypercholesterolemia 0% (0/25) 5 Low TSH 8% (2/25) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review tested concept (M1.EC.13.81) A 25-year-old female presents with recent muscle weakness, fatigue, and constipation. Physical examination reveals a bradycardic patient with cool, dry skin. Which of the following lab values would be most likely to be present with this patient's presentation? Tested Concept QID: 100382 Type & Select Correct Answer 1 Elevated serum calcitonin 2% (2/106) 2 Elevated serum CK 17% (18/106) 3 Low serum TSH 36% (38/106) 4 Activating TSH-receptor immunoglobulins 21% (22/106) 5 Hypocalcemia 23% (24/106) M 2 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept