Endocrinology Module 5

A 27-year-old nulliparous woman presents with a mildly elevated serum prolactin level of 900 mIU/L on two separate occasions, obtained through a private laboratory. She reports regular menstrual cycles and denies galactorrhoea, headaches, or visual disturbances. She is not sexually active and has no other symptoms.

What is the most appropriate next step in the management of this patient?

Look for the presence of macroprolactin using polyethylene glycol (PEG) precipitation

Correct Incorrect Correct answer

Perform a serum beta-hCG test to rule out pregnancy

Correct Incorrect Correct answer

Check her thyroid function tests to exclude hypothyroidism

Correct Incorrect Correct answer

Reassure the patient and recommend no further investigation

Correct Incorrect Correct answer

Arrange a pituitary MRI to rule out a prolactinoma

Correct Incorrect Correct answer

Which of the following interventions has the strongest evidence for improving longevity?

caloric restriction

Correct Incorrect Correct answer

antioxidants

Correct Incorrect Correct answer

lower levels of insulin like growth factor (IGF-1)

Correct Incorrect Correct answer

Inheriting Hutchinson Gilford Syndrome

Correct Incorrect Correct answer

combination of statin and biphosphonates

Correct Incorrect Correct answer

What is the single most important intervention to reduce the risk of developing or worsening thyroid eye disease (Graves’ orbitopathy)?

Stop smoking

Correct Incorrect Correct answer

Radioactive iodine

Correct Incorrect Correct answer

Carbimazole

Correct Incorrect Correct answer

Propylthiouracil

Correct Incorrect Correct answer

Reduce alcohol intake

Correct Incorrect Correct answer

What is the most appropriate definitive treatment for a non-compressive 3cm solitary toxic thyroid nodule in a 65 year old man with multiple co-morbidities?

Radioactive iodine

Correct Incorrect Correct answer

Carbimazole

Correct Incorrect Correct answer

Thyroid lobectomy

Correct Incorrect Correct answer

Propylthiouracil

Correct Incorrect Correct answer

Thyroxine

Correct Incorrect Correct answer

The Jod-Basedow effect is a phenomenon of iodine-induced hyperthyroidism.

Which of the following is most closely associated with this effect?

Amiodarone induced thyrotoxicosis (Type I)

Correct Incorrect Correct answer

Amiodarone induced thyrotoxicosis (Type II)

Correct Incorrect Correct answer

Solitary toxic nodule

Correct Incorrect Correct answer

Multinodular goitre

Correct Incorrect Correct answer

Graves disease

Correct Incorrect Correct answer

What is the primary mechanism of Type II amiodarone-induced thyrotoxicosis?

Direct cytotoxic effect on thyroid follicular epithelial cells

Correct Incorrect Correct answer

High iodine content in patient with underlying thyroid abnormality

Correct Incorrect Correct answer

By blocking production of T3

Correct Incorrect Correct answer

Jod Basedow effect.

Correct Incorrect Correct answer

Wolff Chaikoff effect

Correct Incorrect Correct answer

Which of the following features suggests Type II rather than Type I amiodarone-induced thyrotoxicosis?

Raised IL-6 and thyroglobulin levels

Correct Incorrect Correct answer

Large goitre

Correct Incorrect Correct answer

High uptake of radioactive iodine

Correct Incorrect Correct answer

No response to steroid.

Correct Incorrect Correct answer

Increased blood flow on colour flow doppler

Correct Incorrect Correct answer

Which of the following features is most suggestive of a benign rather than malignant thyroid nodule?

Slow growth.

Correct Incorrect Correct answer

Firm or hard nodule

Correct Incorrect Correct answer

Positive family history of medullary thyroid ca or MEN

Correct Incorrect Correct answer

Fixation of nodule

Correct Incorrect Correct answer

PET incidentaloma

Correct Incorrect Correct answer

Which of the following is NOT an ultrasonographic feature of thyroid malignancy?

Predominantly cystic composition

Correct Incorrect Correct answer

Markedly hypoechogenicity

Correct Incorrect Correct answer

Intranodular vascularity

Correct Incorrect Correct answer

Absence of halo

Correct Incorrect Correct answer

Irregular margin

Correct Incorrect Correct answer

A 37-year-old patient has a thyroid nodule measuring more than 4 cm with benign cytology on fine-needle aspiration.

What is the most appropriate next step in management?

Diagnostic lobectomy.

Correct Incorrect Correct answer

Treat with carbimazole

Correct Incorrect Correct answer

Follow up scan in 3 months

Correct Incorrect Correct answer

Follow up in scan 2 weeks

Correct Incorrect Correct answer

Treat with thyroxine

Correct Incorrect Correct answer

Of all palpable thyroid nodules, approximately what percentage are malignant?

5-10%

Correct Incorrect Correct answer

80%

Correct Incorrect Correct answer

10-15%

Correct Incorrect Correct answer

1-2%

Correct Incorrect Correct answer

50%

Correct Incorrect Correct answer

A 42-year-old male is found to have a malignant thyroid tumour (papillary thyroid carcinoma) measuring more than 1 cm confirmed on FNA cytology. There is no evidence of extrathyroidal extension or lymph node metastases on ultrasound.

What is the most appropriate next step in management?

Total thyroidectomy

Correct Incorrect Correct answer

Follow up scan in 1 month

Correct Incorrect Correct answer

Treat with radioactive iodine

Correct Incorrect Correct answer

Thyroxine suppression

Correct Incorrect Correct answer

Treat with recombinant human TSH

Correct Incorrect Correct answer

A patient with intermediate-risk papillary thyroid carcinoma has undergone total thyroidectomy.

What is the most appropriate next step in management?

Post-operative ablation with radioactive iodine

Correct Incorrect Correct answer

Commence Propylthiouracil

Correct Incorrect Correct answer

Commence carbimazole

Correct Incorrect Correct answer

Follow up scan in 3 weeks

Correct Incorrect Correct answer

Do nothing

Correct Incorrect Correct answer

Which of the following typically decreases in thyrotoxicosis?

Low-density lipoprotein cholesterol (LDL-C)

Correct Incorrect Correct answer

Osteocalcin

Correct Incorrect Correct answer

Alkaline phosphatase

Correct Incorrect Correct answer

Atrial natriuretic hormone

Correct Incorrect Correct answer

Ferritin

Correct Incorrect Correct answer

TSH is the best marker of thyroid status for the following conditions EXCEPT:

TSH-secreting pituitary adenoma

Correct Incorrect Correct answer

Grave's disease

Correct Incorrect Correct answer

Toxic multinodular goitre

Correct Incorrect Correct answer

Iodine induced thyrotoxicosis

Correct Incorrect Correct answer

Toxic adenoma

Correct Incorrect Correct answer

Which of the following conditions has the highest rate of positivity for anti-thyroid peroxidase (anti-TPO) antibodies?

Autoimmune thyroiditis (Hashimoto's thyroiditis)

Correct Incorrect Correct answer

Grave's disease

Correct Incorrect Correct answer

General population

Correct Incorrect Correct answer

Diabetes

Correct Incorrect Correct answer

Pregnancy

Correct Incorrect Correct answer

What is the approximate half-life of thyroxine (T4)?

7 days

Correct Incorrect Correct answer

2 weeks

Correct Incorrect Correct answer

1 day

Correct Incorrect Correct answer

30 minutes

Correct Incorrect Correct answer

10 hours

Correct Incorrect Correct answer

Which of the following is NOT beneficial in the treatment of amiodarone-induced thyrotoxicosis?

radioactive iodine

Correct Incorrect Correct answer

thyroidectomy

Correct Incorrect Correct answer

carbimazole

Correct Incorrect Correct answer

cholestyramine

Correct Incorrect Correct answer

prednisone

Correct Incorrect Correct answer

For which of the following clinical presentations is thyroid ultrasound MOST helpful as the initial imaging investigation?

neck mass

Correct Incorrect Correct answer

neck pain

Correct Incorrect Correct answer

thyrotoxicosis

Correct Incorrect Correct answer

dysphonia

Correct Incorrect Correct answer

dysphagia

Correct Incorrect Correct answer

Which of the following interventions would be most effective in preventing recurrence of non-metastatic papillary thyroid cancer following total thyroidectomy?

supraphysiological thyroid replacement.

Correct Incorrect Correct answer

thyroid remnant ablation using radioactive iodine

Correct Incorrect Correct answer

annual thyroid ultrasound to detect early recurrence

Correct Incorrect Correct answer

cervical lymph node clearance

Correct Incorrect Correct answer

iodine reduced diet

Correct Incorrect Correct answer

What is the most common type of thyroid cancer?

Papillary

Correct Incorrect Correct answer

Follicular

Correct Incorrect Correct answer

Anaplastic

Correct Incorrect Correct answer

Lymphoma

Correct Incorrect Correct answer

Medullary cell

Correct Incorrect Correct answer

Which of the following thyroid tumours carries the highest mortality?

1 cm medullary thyroid carcinoma with lymph node metastases

Correct Incorrect Correct answer

2 cm papillary thyroid carcinoma with lymph node metastases.

Correct Incorrect Correct answer

3 cm follicular thyroid carcinoma with no lymph node metastases.

Correct Incorrect Correct answer

2 cm follicular thyroid carcinoma with lymph node metastases.

Correct Incorrect Correct answer

4 cm thyroid adenoma

Correct Incorrect Correct answer

What is the primary rationale for administering radioactive iodine following thyroidectomy for papillary thyroid carcinoma?

enable tumour surveillance

Correct Incorrect Correct answer

decrease mortality

Correct Incorrect Correct answer

decrease rate of tumour progression

Correct Incorrect Correct answer

simplify thyroxine replacement in the post operative period

Correct Incorrect Correct answer

screen for occult metastases

Correct Incorrect Correct answer

A 42-year-old patient presents with an enlarging neck mass. Serum TSH is normal. Neck ultrasound shows a 2 cm homogeneous solid mass consistent with a thyroid nodule.

What is the most appropriate next step in management?

fine needle aspiration and cytological examination

Correct Incorrect Correct answer

check serum thyroglobulin

Correct Incorrect Correct answer

arrange a thyroid technetium scan

Correct Incorrect Correct answer

sequence RET gene

Correct Incorrect Correct answer

check serum calcitonin

Correct Incorrect Correct answer

A 26-year-old Chinese male presents after collapsing during strenuous exercise. On examination, he has flaccid paralysis of both legs, reduced power in the arms, and a weak voice. Reflexes are absent bilaterally but sensation is intact. He also has bilateral ptosis, a prominent symmetrical goitre, a heart rate of 140 bpm, and fine finger tremors.

Which test is most helpful to explain his recent collapse?

serum potassium

Correct Incorrect Correct answer

ECG

Correct Incorrect Correct answer

serum TSH

Correct Incorrect Correct answer

serum troponin

Correct Incorrect Correct answer

serum corrected calcicum

Correct Incorrect Correct answer

In patients with subclinical hyperthyroidism, which of the following is the strongest indication for recommending definitive treatment?

Atrial fibrillation

Correct Incorrect Correct answer

Neuropsychiatric symptom

Correct Incorrect Correct answer

Reduced bone mineral density

Correct Incorrect Correct answer

Previous Fracture

Correct Incorrect Correct answer

Pre-menopausal women

Correct Incorrect Correct answer

Which of the following hormones is capable of activating the TSH receptor on the thyroid gland?

Beta-hCG (human chorionic gonadotropin)

Correct Incorrect Correct answer

Aldosterone

Correct Incorrect Correct answer

Testosterone

Correct Incorrect Correct answer

Atrial natriuretic peptide

Correct Incorrect Correct answer

Adrenaline

Correct Incorrect Correct answer

A patient was diagnosed with papillary carcinoma in the left lobe of the thyroid and underwent subtotal thyroidectomy 4 years ago. She was advised that surgery had cured her cancer and was not offered any further treatment or follow-up. She is on no medication and is clinically euthyroid. No mass is palpable on examination. Ultrasound shows no evidence of lymphadenopathy or residual thyroid mass.

What is the most appropriate next step in management?

prescribe thyroxine

Correct Incorrect Correct answer

order serum thyroglobulin

Correct Incorrect Correct answer

arrange low dose I131 scan

Correct Incorrect Correct answer

arrange high dose I 131 for remnant ablation

Correct Incorrect Correct answer

reassurance

Correct Incorrect Correct answer

Which of the following scenarios would best explain the following thyroid function test results?

TSH: 3.2 mIU/L (reference: 0.4–4.0)
fT4: 37 pmol/L (reference: 9–19)
fT3: 8.2 pmol/L (reference: 3.5–6.5)

TSH-secreting pituitary adenoma

Correct Incorrect Correct answer

untreated Grave's disease

Correct Incorrect Correct answer

toxic thyroid nodules

Correct Incorrect Correct answer

thyroiditis

Correct Incorrect Correct answer

recombinant TSH administration

Correct Incorrect Correct answer

A 48-year-old man is reviewed 6 months following trans-sphenoidal resection of a non-functioning pituitary macroadenoma. He was commenced on levothyroxine 3 months after surgery. He now complains of increasing fatigue and weight gain. Thyroid function tests, serum testosterone, and morning cortisol are all normal.

What is the most likely diagnosis?

growth hormone deficiency

Correct Incorrect Correct answer

thyrotoxicosis

Correct Incorrect Correct answer

hypoandrogenism

Correct Incorrect Correct answer

hypocortisolism

Correct Incorrect Correct answer

abulia from hypothalamic injury

Correct Incorrect Correct answer

Endocrinology Module 5

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