Listen to the podcast for why each multiple choice answer is right or wrong!

1. A 38-year-old woman has a developed a solid and quite firm thyroid mass that is approximately 1 cm diameter by palpation. She does not have any hoarseness, difficulty breathing or swallowing, or symptoms of thyroid disease. She no history of radiation, cancer, or familial history of thyroid disease. You order a Thyroid panel that includes TSH, Free T3 and T4. What would you do next?

A Fine-needle aspiration biopsy of the nodule

B Observation to see if the nodule increases in size

C Radioactive iodine uptake test (RAIU)

D Resection of the nodule

E Soft tissue neck ultrasound

2. You’ve been treating a 35-year-old female patient for thyroid disease and she comes back for a yearly exam. Her meds are significant for 100 ugm of levothyroxine once daily. Blood pressure is 124/84, pulse 72 bpm, respirations 13 bpm, and she is afebrile. Her physical examination is normal. Since you’re a PA who’s on top of your game, you’ve already had her come a week ago to draw her yearly physical labs that include a thyroid panel and you discuss the following results with her: Her TSH level is 11.5 uIU/mL (normal 0.4 to 5.0 uIU/mL). What is your next step in her treatment?

A Draw a free T3 and free T4.

B Decrease levothyroxine to 88 ugm daily and recheck her TSH in 4 to 6 weeks to adjust if necessary.

C Increase her levothyroxine to 112 ugm daily and recheck her TSH in 4 to 6 weeks to adjust if necessary.

D Since she is asymptomatic no adjustment to levo is necessary. Recheck levels in 6 months

to increase her levothyroxine dose.

3. 24-year-old woman presents to your office with symptoms of heart palpitations, sore neck, and excessive sweating when other people say its cold. She has no significant history of surgery or medical conditions and is not on any medications. In office, her BP = 124/68, pulse = 110 beats per minute, respirations = 18 per minute, and temperature = 101 o F orally. Upon exam, her thyroid is mildly enlarged without nodules, and severely tender. RAIU is depressed. No local erythema or heat is noted. What is the most likely diagnosis in this patient?

A Thyroid abscess

B Papillary thyroid cancer

C Hashimoto's thyroiditis

D Graves' disease

E Subacute thyroiditis

Answers

1. E Soft tissue neck ultrasound

2. C Increase her levothyroxine to 112 ugm daily and recheck her TSH in 4 to 6 weeks to adjust if necessary.

3. E Subacute thyroiditis

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