WorksheetsMED2: Thyroid
Total questions: 15
Worksheet time: 10mins
A 28-year-old woman presents with palpitations, weight loss, and heat intolerance. On examination, she has a smooth goitre and a resting tremor. Blood tests show:
TSH: <0.01 mU/L (normal 0.4–4.0)
Free T4: 38 pmol/L (normal 9–25)
Which of the following is the most likely underlying diagnosis?
Toxic multinodular goitre.
Graves' disease.
Iodine deficiency.
Pituitary adenoma.
Which auto-antibodies may be present in Hashimoto's (autoimmune) thyroiditis? Select more than one answer.
TSH receptor antibody.
Anti-nuclear antibodies.
Anti-thyroid peroxidase antibody (anti-TPO).
Anti-thyroglobulin antibody (anti-Tg).
A 37-year-old woman presents to her GP with weight gain, heavy periods, and low mood. Which of the following is the most likely diagnosis?
Primary hypothyroidism.
Secondary hypothyroidism.
Primary hyperthyroidism.
Secondary hyperthyroidism.
What do the following thyroid function results suggest?
TSH = 9 (0.4 - 5.0)
T4 = 10 (9.0 - 22.0)
T3 = 4 (3.5 - 7.8)
Primary hyperthyroidism.
Primary hypothyroidism.
Subclinical hyperthyroidism.
Subclinical hypothyroidism.
A 50-year-old woman presents with weight loss, anxiety, and heat intolerance. You notice that her eyes are bulging and suspect that she may have Graves' disease. What panel of blood tests would you most expect to see?
High TSH. Low T3/T4.
Low TSH. High T3/T4.
High TSH. High T3/T4.
Low TSH. Low T3/T4.
Which of these clinical signs is NOT specific to Graves' disease?
Exophthalmos.
Pre-tibial myxoedema.
Goitre.
Thyroid acropachy.
Which of these is NOT a curative treatment for primary hyperthyroidism?
Beta-blocker.
Carbimazole / PTU.
Thyroidectomy.
Radioactive iodine.
A young woman presents with a painful neck swelling. She reports feeling tired, low in mood, and has been constipated. She had 'the flu’ 4-weeks ago.
Which of the following is the most likely diagnosis?
Hashimoto's thyroiditis.
Graves' disease.
Pituitary adenoma.
De Quervain's thyroiditis.
A 50-year-old woman with known hypothyroidism presents for a levothyroxine dose review. You see this set of blood results: TSH - high. T3/T4 - normal.
What is the most appropriate initial action?
Increase levothyroxine dose.
Decrease levothyroxine dose.
Ask about compliance with treatment.
Stop levothyroxine.
A 53-year-old woman has been complaining of tingling and cramping in her hands. She then develops a tonic-clonic seizure. 3-days ago she had a total thyroidectomy for thyroid cancer. What is the most likely cause of her seizure?
Sepsis
Hypoglycaemia
Hypothyroidism
Hypocalcaemia
A 65-year-old man presents to GP with weight gain, cold intolerance, and visual loss. On examination, he is found to have a bitemporal hemianopia. Which of the following thyroid function test results is most likely to belong to this patient?
TSH: low.
T4: low. T3 low.
TSH: high.
T4: low. T3 low.
TSH: high.
T4: normal. T3 normal.
TSH: low.
T4: high. T3 high.
You are reviewing the blood results of a patient on the oncology ward. They have a corrected calcium of 3.5mmol/L and you diagnose hypercalcaemia, likely due to bony metastases. What is the first stage of treatment?
IV bisphosphonates
IV 0.9% sodium chloride
Prednisolone 40mg OD
Sepsis screen
A 60-year-old woman presents with recurrent renal stones. Blood tests show:
Corrected calcium: 3.05 mmol/L (normal 2.2–2.6)
Phosphate: low
PTH: elevated
What is the most likely diagnosis?
Vitamin D deficiency
Chronic kidney disease
Primary hyperparathyroidism.
Secondary hyperparathyroidism
Tertiary hyperparathyroidism
Which of the following hormones increases the secretion of calcium in the urine?
Cortisol
Insulin
Calcitonin
Anti-diuretic hormone
Parathyroid hormone
Which of the following is a possible side effect of carbimazole therapy in the treatment of hyperthyroidism?
Bradycardia.
Hypercalcaemia.
Neutropaenia.
Weight gain.
