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29. What should be done once the diagnosis of primary hypothyroidism is made if the thyroid gland is normal on physical examination?
a. Further imaging or serologic testing is unnecessary if the thyroid gland is normal on physical exam
b. However in cases of secondary hypothyroidism further testing is needed to determine whether the cause is a hypothalamic or pituitary problem.
30. How do you test for a hypothalamic or pituitary cause of hypothyroidism?
a. TRH test.
b. We GRH is injected IV, a normally functioning pituitary will release increased amount of TSH that can be measured in about 30 min.
c. No increase TSH after injection of TRH suggests a malfunctioning pituitary gland.
d. In cases where pituitary dysfunction is suspected, imaging pituitary gland to detect microadenomas and testing of other hormones that are dependent on pituitary stimulation are indicated.
31. Treatment of hypothyroidism?
a. Most healthy adults with hypothyroidism require 1.7 µg per kilogram per day
b. :~1 µg per kilogram
c. Is usually announced between 0.10 and 0.15 g per day of level thyroxine
32. How may the adequacy of level thyroxin dosing be determined in a patient with intact hypothalamic-pituitary axis?
a. Serial TSH measurements
b. Evaluation of TSH level should be performed no earlier than 4 weeks after an adjustment to medication has been made.
33. Note: the full effects of thyroid replacement on TSH level may not be present until 8 weeks of treatment.
33. Note: the full effects of thyroid replacement on TSH level may not be present until 8 weeks of treatment.
34. What happens to the thyroid level with aging?
a. With Increased age, thyroid binding decreases as a consequence of a drop in serum albumin level and medication dosage may need to be reduced by up to 20%
b. Annual monitoring of the TSH level if necessary to avoid over placement.
35. What should be done for findings of thyroid nodules?
a. Further workup is indicated, as the incidence of malignancy in solitary nodules is estimated at 5 to 6%.
36. Note: functional adenomas present with hypothyroidism are rarely malignant. These represent less than 10% of all nodules.
36. Note: functional adenomas present with hypothyroidism are rarely malignant. These represent less than 10% of all nodules.
37. When do nonfunctioning nodules require biopsy?
a. When they measure > 1 cm by examination or ultrasonography.
b. This can be done by fine needle aspiration (FNA), which is highly sensitive test
c. Results of the FNA determine the management and treatment
d. Cytologic evaluation of FNA specimens reported as being nondiagnostic, benign, indeterminate, or malignant .
38. Significance of follicular findings with FNA?
a. Calyculus of malignancy cannot be distinguished cytologically from the benign equivalent, and thus is often read as indeterminate
b. These patients should be referred to surgery to obtain it definitive evaluation.
c. Papillary, medullary, anaplastic thyroid carcinomas can be diagnosed accurately by FNA
39. What ultrasound findings of thyroid nodules are suggestive of malignancy?
a. Irregular margins
b. Internodular vascular spots
c. Microcalcifications