NURS 623 FINAL WORKSHEET FOR EXAM 2
Working through the questions should help point out areas you need to spend more time
further reviewing. Also, please look over the review guide in the module section.
Thyroid
1. What are the initial lab tests that are ordered to evaluate thyroid function?
TSH (thyroid-stimulating hormone or thyrotropin):
o Normal range: TSH of 0.5 to 5.0 mU/L (third-generation test) has normal range.
o TSH is used for both screening and monitoring response to treatment.
– Recheck TSH every 6 to 8 weeks.
--Dose of levothyroxine (Synthroid) is based on the TSH level.
o Goal is a TSH less than 5.0 mU/L.
– When TSH is stable, recheck every 6 to 12 months.
Thyroxine (T4) and triiodothyronine (T3)
2. Name the two thyroid hormones produced by the thyroid?
thyroxine (T4) and triiodothyronine (T3)
3. Name the hormone produced by the pituitary gland, state the purpose of the hormone.
The anterior pituitary gland secretes six hormones. “stimulating hormones”
growth hormone (GH)
o Stimulates somatic growth of the body
prolactin (PRL)
o Affects lactation and milk production
, follicle-stimulating hormone (FSH)
o Stimulates the ovaries enabling growth of follicles (or eggs)
o Production of estrogen
luteinizing hormone (LH)
o Stimulates the ovaries to ovulate
o Production of progesterone (by corpus luteum)
o In males, LH stimulates the testicles (Leydig cells) to produce testosterone
adrenocorticotropic hormone (ACTH)
o Stimulates the adrenal glands (two portions of gland—medulla and cortex
o Production of glucocorticoids (cortisol) and mineralocorticoids (aldosterone)
thyroid-stimulating hormone (TSH)
o Stimulates thyroid gland
o Production of triiodothyronine (T3) and thyroxine (T4)
Melanocyte-stimulating hormone
o Production of melatonin in response to UV light;
o highest levels at night between 11 p.m. and 3 a.m.
4. Fill in the appropriate response (increased or decreased):
(Review negative feedback)
The TSH level would be very low and the serum free T3/t4 elevated in Grave’s disease.
The TSH level would be high and the T3/t4 low in Hashimoto’s disease.
In a pituitary abnormality you would expect to see the TSH high and the T3/T4 low.
o Hypothyroidism Secondary
o Secondary hypothyroidism involves decreased activity of the
thyroid caused by failure of the pituitary gland.
• Medications can alter lab values (anabolic steroid, adrogens, estrogens, phenytoin,
salicylates, heparin, iodine containing compounds
5. What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to
differentiate between Grave’s disease and subacute thyroiditis and toxic nodular goiters?
, LEIK: Thyroid ultrasound, 24-hour radioactive iodine uptake (RAIU) shows diffuse uptake
(goiter). If solitary toxic nodule, shows warm or “hot” nodule or “cold” nodule. Absolute
contraindications for this test are pregnancy and breastfeeding.
TEXT: A 24-hour radioactive iodine uptake (RAIU) test can differentiate Graves’ disease from
subacute thyroiditis and toxic nodular goiters, thereby refining treatment recommendations. It
identifies areas of increased and decreased thyroid function, often termed hot and cold spots,
within the gland.
Patients with toxic nodular goiter and Graves’ disease have a high RAIU, whereas in subacute
thyroiditis, iodine uptake is low.
Graves Subacute Thyroiditis Toxic Nodular
Goiters
Diagnosis Very low (or diagnosis of subacute hyperthyroid patients
undectectable) TSH thyroiditis is based with physical
primarily upon clinical examination or
High free T4 & T3 manifestations ultrasound findings
suggesting nodular
(the presence of neck thyroid disease
pain, often radiating
upward to the jaw;
marked thyroid
tenderness; and a
diffuse goiter).
Diagnostic positive thyrotropin thyroid function tests obtain a radioactive
Findings receptor antibodies iodine uptake scan as
(TRAb) AKA thyroid (thyroid-stimulating our initial test to
stimulating hormone [TSH], distinguish toxic
immunoglobulin (TSI). nodular goiter and
free thyroxine [T4], toxic adenoma from
triiodothyronine [T3]) Graves' disease
should be obtained.
Although symptoms
and signs of
hyperthyroidism may
or may not be present,
serum TSH is usually
suppressed (typically
<0.1 mU/L)
and free T4 and T3
Working through the questions should help point out areas you need to spend more time
further reviewing. Also, please look over the review guide in the module section.
Thyroid
1. What are the initial lab tests that are ordered to evaluate thyroid function?
TSH (thyroid-stimulating hormone or thyrotropin):
o Normal range: TSH of 0.5 to 5.0 mU/L (third-generation test) has normal range.
o TSH is used for both screening and monitoring response to treatment.
– Recheck TSH every 6 to 8 weeks.
--Dose of levothyroxine (Synthroid) is based on the TSH level.
o Goal is a TSH less than 5.0 mU/L.
– When TSH is stable, recheck every 6 to 12 months.
Thyroxine (T4) and triiodothyronine (T3)
2. Name the two thyroid hormones produced by the thyroid?
thyroxine (T4) and triiodothyronine (T3)
3. Name the hormone produced by the pituitary gland, state the purpose of the hormone.
The anterior pituitary gland secretes six hormones. “stimulating hormones”
growth hormone (GH)
o Stimulates somatic growth of the body
prolactin (PRL)
o Affects lactation and milk production
, follicle-stimulating hormone (FSH)
o Stimulates the ovaries enabling growth of follicles (or eggs)
o Production of estrogen
luteinizing hormone (LH)
o Stimulates the ovaries to ovulate
o Production of progesterone (by corpus luteum)
o In males, LH stimulates the testicles (Leydig cells) to produce testosterone
adrenocorticotropic hormone (ACTH)
o Stimulates the adrenal glands (two portions of gland—medulla and cortex
o Production of glucocorticoids (cortisol) and mineralocorticoids (aldosterone)
thyroid-stimulating hormone (TSH)
o Stimulates thyroid gland
o Production of triiodothyronine (T3) and thyroxine (T4)
Melanocyte-stimulating hormone
o Production of melatonin in response to UV light;
o highest levels at night between 11 p.m. and 3 a.m.
4. Fill in the appropriate response (increased or decreased):
(Review negative feedback)
The TSH level would be very low and the serum free T3/t4 elevated in Grave’s disease.
The TSH level would be high and the T3/t4 low in Hashimoto’s disease.
In a pituitary abnormality you would expect to see the TSH high and the T3/T4 low.
o Hypothyroidism Secondary
o Secondary hypothyroidism involves decreased activity of the
thyroid caused by failure of the pituitary gland.
• Medications can alter lab values (anabolic steroid, adrogens, estrogens, phenytoin,
salicylates, heparin, iodine containing compounds
5. What is the test that assesses the functional status (hot and cold spots) of the thyroid gland to
differentiate between Grave’s disease and subacute thyroiditis and toxic nodular goiters?
, LEIK: Thyroid ultrasound, 24-hour radioactive iodine uptake (RAIU) shows diffuse uptake
(goiter). If solitary toxic nodule, shows warm or “hot” nodule or “cold” nodule. Absolute
contraindications for this test are pregnancy and breastfeeding.
TEXT: A 24-hour radioactive iodine uptake (RAIU) test can differentiate Graves’ disease from
subacute thyroiditis and toxic nodular goiters, thereby refining treatment recommendations. It
identifies areas of increased and decreased thyroid function, often termed hot and cold spots,
within the gland.
Patients with toxic nodular goiter and Graves’ disease have a high RAIU, whereas in subacute
thyroiditis, iodine uptake is low.
Graves Subacute Thyroiditis Toxic Nodular
Goiters
Diagnosis Very low (or diagnosis of subacute hyperthyroid patients
undectectable) TSH thyroiditis is based with physical
primarily upon clinical examination or
High free T4 & T3 manifestations ultrasound findings
suggesting nodular
(the presence of neck thyroid disease
pain, often radiating
upward to the jaw;
marked thyroid
tenderness; and a
diffuse goiter).
Diagnostic positive thyrotropin thyroid function tests obtain a radioactive
Findings receptor antibodies iodine uptake scan as
(TRAb) AKA thyroid (thyroid-stimulating our initial test to
stimulating hormone [TSH], distinguish toxic
immunoglobulin (TSI). nodular goiter and
free thyroxine [T4], toxic adenoma from
triiodothyronine [T3]) Graves' disease
should be obtained.
Although symptoms
and signs of
hyperthyroidism may
or may not be present,
serum TSH is usually
suppressed (typically
<0.1 mU/L)
and free T4 and T3
