ESTUDYR
NURS 5433 FAMILY II: THYROID DISORDERS MOST TESTED QUESTIONS
AND ANSWERS GRADED A+ WITH RATIONALES
Which lab pattern is diagnostic for overt primary hypothyroidism?
A. Low TSH + high free T4
B. Normal TSH + low T4
C. Elevated TSH + low free T4
D. Low TSH + low free T4
Rationale: In primary hypothyroidism the thyroid fails to produce T4, so TSH is elevated from
loss of negative feedback while free T4 is low.
Which lab pattern describes subclinical hypothyroidism?
A. Low TSH + low free T4
B. Elevated TSH + normal free T4
C. Normal TSH + high free T4
D. Low TSH + high free T4
Rationale: Subclinical disease has an abnormal TSH with preserved circulating free T4 and often
minimal symptoms.
What is the most common cause of thyroid disease overall?
A. Iodine excess
B. Radiation exposure
C. Infectious thyroiditis
D. Autoimmune disease (e.g., Hashimoto’s, Graves’)
Rationale: Autoimmune thyroid disorders are the leading cause of both hypo- and hyperthyroid
conditions in many populations.
Maternal hypothyroidism most critically affects fetal development during which timeframe?
A. Third trimester only
B. Entire pregnancy equally
C. First trimester (beginning ~8 weeks)
D. Only during labor
Rationale: The fetus depends on maternal thyroid hormone during early gestation (around 8
weeks) before its own thyroid becomes functional.
Lack of adequate maternal thyroid hormone in the first trimester can lead to:
A. Transient neonatal hyperthyroidism only
B. Increased fetal growth exclusively
C. Permanent neurodevelopmental deficits in the fetus
,ESTUDYR
D. Immunodeficiency in the newborn
Rationale: Maternal hypothyroidism in early pregnancy can impair fetal neurocognitive
development.
By which trimester does the fetus typically produce its own thyroid hormones?
A. First trimester
B. Second trimester
C. Third trimester only
D. Not until after birth
Rationale: Fetal thyroid function becomes established in the second trimester, though
maturation continues thereafter.
When a woman with established hypothyroidism becomes pregnant, levothyroxine
requirements typically:
A. Decrease by 50%
B. Increase by ~25–50%
C. Remain unchanged always
D. Should be stopped during pregnancy
Rationale: Pregnancy increases thyroid-binding globulin and metabolic demands, usually
requiring higher levothyroxine doses.
How soon after delivery can a pregnant woman usually return to her pre-pregnancy
levothyroxine dose?
A. One year after delivery
B. Immediately after delivery (with monitoring)
C. Never — dose always higher postpartum
D. Only after weaning from breastfeeding
Rationale: After delivery the increased thyroid requirements typically normalize; dose reduction
should be individualized and monitored.
Is breastfeeding contraindicated while taking levothyroxine?
A. Yes, always contraindicated
B. Only if dose >300 mcg/day
C. No — breastfeeding is not contraindicated
D. Only if infant is premature
Rationale: Levothyroxine is safe during lactation and recommended to maintain maternal
euthyroidism.
Congenital hypothyroidism left untreated can cause:
A. Transient fever only
, ESTUDYR
B. Exclusive respiratory problems
C. Delayed mental development and impaired growth
D. Immediate hyperactivity and weight loss
Rationale: Thyroid hormone is essential for brain development and growth; untreated
congenital hypothyroidism causes intellectual disability and growth failure.
Classic manifestations of untreated congenital hypothyroidism include:
A. Macrocephaly and hyperactivity
B. Large protruding tongue, potbellied appearance, short stature, delayed development
C. Early puberty and tall stature
D. Excessive sweating and tachycardia
Rationale: Infants show characteristic physical signs from low thyroid hormone affecting growth
and tissue development.
How long should replacement therapy be continued before re-evaluating if congenital
hypothyroidism is permanent?
A. Stop after 1 week always
B. Continue lifelong with no trial off
C. Continue for 3 years then stop for 4 weeks to reassess thyroid function
D. Stop at 6 months regardless
Rationale: A trial off therapy after about 3 years helps differentiate transient from permanent
congenital hypothyroidism.
After the 4-week trial off therapy, an elevated TSH indicates:
A. Adequate endogenous thyroid function
B. Low thyroid production → permanent deficiency → resume replacement
C. Lab error only — ignore it
D. Transient hyperthyroidism
Rationale: A rise in TSH after withdrawal denotes inadequate thyroid production requiring
continued replacement.
After stopping replacement for 4 weeks, normalization of TSH and T4 indicates:
A. Adequate endogenous production → transient deficiency → therapy can be stopped
B. Permanent hypothyroidism always
C. Lab contamination
D. Iodine excess
Rationale: Normal labs after withdrawal suggest the thyroid can produce sufficient hormone,
meaning therapy may no longer be necessary.
NURS 5433 FAMILY II: THYROID DISORDERS MOST TESTED QUESTIONS
AND ANSWERS GRADED A+ WITH RATIONALES
Which lab pattern is diagnostic for overt primary hypothyroidism?
A. Low TSH + high free T4
B. Normal TSH + low T4
C. Elevated TSH + low free T4
D. Low TSH + low free T4
Rationale: In primary hypothyroidism the thyroid fails to produce T4, so TSH is elevated from
loss of negative feedback while free T4 is low.
Which lab pattern describes subclinical hypothyroidism?
A. Low TSH + low free T4
B. Elevated TSH + normal free T4
C. Normal TSH + high free T4
D. Low TSH + high free T4
Rationale: Subclinical disease has an abnormal TSH with preserved circulating free T4 and often
minimal symptoms.
What is the most common cause of thyroid disease overall?
A. Iodine excess
B. Radiation exposure
C. Infectious thyroiditis
D. Autoimmune disease (e.g., Hashimoto’s, Graves’)
Rationale: Autoimmune thyroid disorders are the leading cause of both hypo- and hyperthyroid
conditions in many populations.
Maternal hypothyroidism most critically affects fetal development during which timeframe?
A. Third trimester only
B. Entire pregnancy equally
C. First trimester (beginning ~8 weeks)
D. Only during labor
Rationale: The fetus depends on maternal thyroid hormone during early gestation (around 8
weeks) before its own thyroid becomes functional.
Lack of adequate maternal thyroid hormone in the first trimester can lead to:
A. Transient neonatal hyperthyroidism only
B. Increased fetal growth exclusively
C. Permanent neurodevelopmental deficits in the fetus
,ESTUDYR
D. Immunodeficiency in the newborn
Rationale: Maternal hypothyroidism in early pregnancy can impair fetal neurocognitive
development.
By which trimester does the fetus typically produce its own thyroid hormones?
A. First trimester
B. Second trimester
C. Third trimester only
D. Not until after birth
Rationale: Fetal thyroid function becomes established in the second trimester, though
maturation continues thereafter.
When a woman with established hypothyroidism becomes pregnant, levothyroxine
requirements typically:
A. Decrease by 50%
B. Increase by ~25–50%
C. Remain unchanged always
D. Should be stopped during pregnancy
Rationale: Pregnancy increases thyroid-binding globulin and metabolic demands, usually
requiring higher levothyroxine doses.
How soon after delivery can a pregnant woman usually return to her pre-pregnancy
levothyroxine dose?
A. One year after delivery
B. Immediately after delivery (with monitoring)
C. Never — dose always higher postpartum
D. Only after weaning from breastfeeding
Rationale: After delivery the increased thyroid requirements typically normalize; dose reduction
should be individualized and monitored.
Is breastfeeding contraindicated while taking levothyroxine?
A. Yes, always contraindicated
B. Only if dose >300 mcg/day
C. No — breastfeeding is not contraindicated
D. Only if infant is premature
Rationale: Levothyroxine is safe during lactation and recommended to maintain maternal
euthyroidism.
Congenital hypothyroidism left untreated can cause:
A. Transient fever only
, ESTUDYR
B. Exclusive respiratory problems
C. Delayed mental development and impaired growth
D. Immediate hyperactivity and weight loss
Rationale: Thyroid hormone is essential for brain development and growth; untreated
congenital hypothyroidism causes intellectual disability and growth failure.
Classic manifestations of untreated congenital hypothyroidism include:
A. Macrocephaly and hyperactivity
B. Large protruding tongue, potbellied appearance, short stature, delayed development
C. Early puberty and tall stature
D. Excessive sweating and tachycardia
Rationale: Infants show characteristic physical signs from low thyroid hormone affecting growth
and tissue development.
How long should replacement therapy be continued before re-evaluating if congenital
hypothyroidism is permanent?
A. Stop after 1 week always
B. Continue lifelong with no trial off
C. Continue for 3 years then stop for 4 weeks to reassess thyroid function
D. Stop at 6 months regardless
Rationale: A trial off therapy after about 3 years helps differentiate transient from permanent
congenital hypothyroidism.
After the 4-week trial off therapy, an elevated TSH indicates:
A. Adequate endogenous thyroid function
B. Low thyroid production → permanent deficiency → resume replacement
C. Lab error only — ignore it
D. Transient hyperthyroidism
Rationale: A rise in TSH after withdrawal denotes inadequate thyroid production requiring
continued replacement.
After stopping replacement for 4 weeks, normalization of TSH and T4 indicates:
A. Adequate endogenous production → transient deficiency → therapy can be stopped
B. Permanent hypothyroidism always
C. Lab contamination
D. Iodine excess
Rationale: Normal labs after withdrawal suggest the thyroid can produce sufficient hormone,
meaning therapy may no longer be necessary.
