Thyroid diseases (hyper/hypothyroidism) — MCQs

A 37-year-old man presents to his primary care physician because he has had constipation for the last several weeks. He has also been feeling lethargic and complains that this winter has been particularly cold. He also complains that he has been gaining weight despite no change in his normal activities. He reveals that two months prior to presentation he had what felt like the flu for which he took Tylenol and did not seek medical attention. Several days after this he developed anterior neck pain. Which of the following findings would most likely be seen on biopsy of this patient's abnormality?

A 42-year-old man is referred for an endocrinology consult because of decreased triiodothyronine (T3) hormone levels. He presented to the emergency department 1 week prior to this consultation with pneumonia and was admitted to a medicine service for management of his infection. He has since recovered from his infection after intravenous antibiotic administration. He currently has no symptoms and denies feeling cold or lethargic. A panel of laboratory tests are obtained with the following results: Thyroid-stimulating hormone: 4.7 µU/mL Thyroxine (T4): 6 µg/dL Triiodothyronine (T3): 68 ng/dL Which of the following additional findings would most likely also be seen in this patient?

A 39-year-old female presents to the clinic with the complaints of dry skin for a few months. She adds that she also has constipation for which she started eating vegetables and fruits but with no improvement. She lives with her husband and children who often complain when she turns the air conditioning to high as she cannot tolerate low temperatures. She has gained 5 kgs (11.2 lb) since her last visit 2 months back although her diet has not changed much. Her past medical history is relevant for cardiac arrhythmias and diabetes. She is on several medications currently. Her temperature is 98.6° F (37° C), respirations are 15/min, pulse is 57/min and blood pressure is 132/98 mm Hg. A physical examination is within normal limits. Thyroid function test results are given below: Serum TSH: 13.0 μU/mL Thyroxine (T4): 3.0 μg/dL Triiodothyronine (T3): 100 ng/dL Which of the following medications is most likely to be responsible for her symptoms?

An investigator is studying a drug that acts on the thyroid hormone pathway. Levels of serum free T3 and T4 in healthy participants are measured before and after administration of the drug. After administration, there is a decrease in the average serum free T3 level, while the average serum free T4 level is increased compared to initial serum studies. Inhibition of which of the following is the most likely mechanism of action of this drug?

A 39-year-old woman with type 1 diabetes mellitus comes to the physician because of a 2-month history of fatigue and hair loss. She has smoked one pack of cigarettes daily for the past 15 years. Her only medication is insulin. Her pulse is 59/min and blood pressure is 102/76 mm Hg. Physical examination shows dry skin, coarse hair, and a nontender, diffuse neck swelling in the anterior midline. Further evaluation of this patient is most likely to show which of the following findings?

A 31-year-old female presents to the clinic with excessive anxiety and palpitations for a month. She also mentions loss of 2.72 kg (6 lb) of her weight over the last month. Her past medical history is insignificant. She does not smoke nor does she drink alcohol. Her temperature is 37°C (98.6°F), pulse is 81/min, respiratory rate is 23/min, and blood pressure is 129/88 mm Hg. On examination, mild exophthalmos is noted. Heart and lung examination is normal including cardiac auscultation. What is the most likely cause of her symptoms?

A 34-year-old woman presents to the physician because of fever and sore throat for 2 days. She also reports generalized body pain and fatigue over this period. She was diagnosed with Graves’ disease 6 months ago. Because of arthralgias and rash due to methimazole 3 months ago, her physician switched methimazole to PTU. She appears ill. The vital signs include: temperature 38.4℃ (101.1℉), pulse 88/min, respiratory rate 12/min, and blood pressure 120/80 mm Hg. A 1 × 1 cm ulcer is seen on the side of the tongue and is painful with surrounding erythema. Examination of the neck, lungs, heart, and abdomen shows no abnormalities. She had normal liver aminotransferases last week. Which of the following is the most important diagnostic study at this time?

A 19-year-old African American male with a history of bipolar I disorder presents to the psychiatrist for a follow-up visit. During the session, the patient explains that for the past 2 months he has felt significantly fatigued and constipated. He is always complaining of feeling cold and has gained several pounds although his diet has not changed. A blood sample was sent for analysis, revealing the following: TSH - 6 mIU/L (nl = 0.4-4.0 mIU/L), free T4 - 0.4 ng/dL (nl = 0.7-1.9 ng/dL), and serum T4 - 2.1 mcg/dL (nl = 4.6-12 mcg/dL). Which of the following is responsible for these abnormalities?

A previously healthy 27-year-old man comes to the physician because of a 3-week history of anxiety, diarrhea, and a 4.1-kg (9-lb) weight loss. On questioning, he also reports that he noticed a painless mass on his left testicle 2 weeks ago. His pulse is 110/min and irregular and blood pressure is 150/70 mm Hg. Examination shows diaphoresis and a fine tremor of the outstretched fingers. Testicular examination shows a 3-cm, firm, nontender mass on the left scrotum that does not transilluminate. This patient's underlying condition is most likely to be associated with which of the following findings?

A 28-year-old woman comes to the physician because of a 1-year history of intermittent buzzing in both her ears. She says she sometimes has episodes of mild dizziness which resolve spontaneously. She has a 15-year history of type 1 diabetes mellitus and episodes of low back pain. She does not smoke or drink alcohol. Current medications include insulin and aspirin. She works as a trombonist for a symphony orchestra. Her vital signs are within normal limits. On otoscopic examination, the tympanic membrane appears normal. Bone conduction is greater than air conduction in both ears. Weber test shows no lateralization. Which of the following is the most likely diagnosis?