Chapter·PhysiologyEndocrine system (thyroid, adrenal, pancreas)

Regulation of thyroid functionDownloads

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1

A 27-year-old woman comes to the physician because of a 2-month history of palpitations, diaphoresis, and a 5-kg (11-lb) weight loss. Her pulse is 101/min and blood pressure is 141/84 mm Hg. Physical examination shows a fine tremor when the fingers are outstretched. After confirmation of the diagnosis, treatment is begun with an antithyroid medication. The physician emphasizes the need for adequate contraception because of the increased risk of severe fetal malformations associated with the use of this medication, which is why its use is discouraged in the first trimester of pregnancy. Which of the following best describes the mechanism of action of this drug?

AInhibition of thyroid hormone release

BInhibition of peripheral conversion of T4 to T3

CDecreased iodide uptake by follicular cells

DSuppression of thyroid-stimulating hormone release

EInhibition of iodide ion oxidation

2

A 27-year-old G1P0 at 12 weeks estimated gestational age presents for prenatal care. The patient says she has occasional nausea and vomiting and a few episodes of palpitations and diarrhea this last week. Physical examination is unremarkable, except for a heart rate of 145/min. Basic thyroid function tests are shown in the table below. Which of the following additional laboratory tests would be most useful in assessing this patient's condition? Thyroid-stimulating hormone (TSH) 0.28 mIU/L (0.3–4.5 mIU/L) Total T4 12 µg/dL (5.4–11.5 µg/dL)

AThyrotropin receptor antibodies (TRAb)

BTotal triiodothyronine (T3) levels

CThyroid peroxidase (TPO) antibodies

DFree thyroxine (T4) levels

EThyroxine-binding globulin (TBG) levels

3

A 49-year-old woman presents to the office because of tremors for 2 months. She says that her hands have been shaking a lot, especially when she feels stressed. In addition, she has been sweating more than usual and has lost 8 kg (17.6 lb) in the last 2 months. She has a past medical history of vitiligo. Her vital signs are a heart rate of 98/min, a respiratory rate of 14/min, a temperature of 37.6°C (99.7°F), and a blood pressure of 115/75 mm Hg. Physical examination shows a fine, bilateral hand tremor and a diffuse goiter. Which of the following hormonal imbalances is most likely present?

ALow TSH, high free T4, and high free T3

BHigh TSH, high free T4, and high free T3

CHigh TSH, normal free T4, and normal free T3

DLow TSH, normal free T4, and normal free T3

EHigh TSH, low free T4, and low free T3

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