The thyroid gland serves as the master regulator of the body’s metabolism, and its dysfunction leads to the common yet complex conditions of hypothyroidism and hyperthyroidism. The management of these disorders, a core topic in the Patient Care 5 endocrinology module, requires pharmacists to be experts in thyroid hormone replacement, antithyroid medications, and therapeutic monitoring. This quiz will test your knowledge on the pathophysiology, diagnosis, and pharmacologic management of thyroid disease.
1. The thyroid gland primarily produces which two hormones?
- a. TSH and TRH
- b. Thyroxine (T4) and Triiodothyronine (T3)
- c. Cortisol and Aldosterone
- d. Calcitonin and Parathyroid Hormone
Answer: b. Thyroxine (T4) and Triiodothyronine (T3)
2. In the hypothalamic-pituitary-thyroid (HPT) axis, which hormone is released from the pituitary gland to stimulate the thyroid?
- a. Thyrotropin-releasing hormone (TRH)
- b. Thyroid-stimulating hormone (TSH)
- c. Corticotropin-releasing hormone (CRH)
- d. Gonadotropin-releasing hormone (GnRH)
Answer: b. Thyroid-stimulating hormone (TSH)
3. A patient presents with fatigue, weight gain, cold intolerance, and constipation. Their lab results show a high TSH and a low free T4. This is consistent with:
- a. Hyperthyroidism
- b. Hypothyroidism
- c. Euthyroid sick syndrome
- d. Cushing’s syndrome
Answer: b. Hypothyroidism
4. What is the most common cause of hypothyroidism in iodine-sufficient areas like the United States?
- a. Iodine deficiency
- b. Graves’ disease
- c. Hashimoto’s thyroiditis
- d. A pituitary adenoma
Answer: c. Hashimoto’s thyroiditis
5. What is the drug of choice for treating hypothyroidism?
- a. Liothyronine (T3)
- b. Methimazole
- c. Levothyroxine (T4)
- d. Propranolol
Answer: c. Levothyroxine (T4)
6. The “Thyroid Gland and its Disorders” is a specific learning module in which course?
- a. PHA5787C Patient Care 5
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5787C Patient Care 5
7. A key counseling point for a patient starting levothyroxine is to take the medication:
- a. With a large meal to improve absorption.
- b. At bedtime with a glass of milk.
- c. On an empty stomach, 30-60 minutes before breakfast, separated from other medications and supplements.
- d. Only when they feel symptoms of fatigue.
Answer: c. On an empty stomach, 30-60 minutes before breakfast, separated from other medications and supplements.
8. A patient presents with weight loss, heat intolerance, anxiety, and palpitations. Their lab results show a low TSH and a high free T4. This is consistent with:
- a. Hypothyroidism
- b. Hyperthyroidism
- c. Adrenal insufficiency
- d. A normal thyroid state
Answer: b. Hyperthyroidism
9. What is the most common cause of hyperthyroidism?
- a. Hashimoto’s thyroiditis
- b. A toxic multinodular goiter
- c. Graves’ disease
- d. A TSH-secreting pituitary adenoma
Answer: c. Graves’ disease
10. Methimazole and propylthiouracil (PTU) are thionamides used to treat hyperthyroidism. What is their primary mechanism of action?
- a. They block the release of TSH from the pituitary.
- b. They destroy the thyroid gland with radiation.
- c. They inhibit the thyroid peroxidase enzyme, blocking the synthesis of thyroid hormones.
- d. They block beta-receptors to control symptoms.
Answer: c. They inhibit the thyroid peroxidase enzyme, blocking the synthesis of thyroid hormones.
11. The introduction to the thyroid gland and its disorders is a topic within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
12. Which of the following medications is used to control symptoms like tachycardia and tremor in hyperthyroidism?
- a. Levothyroxine
- b. Propranolol
- c. Methimazole
- d. Radioactive iodine
Answer: b. Propranolol
13. A patient on levothyroxine should have which lab parameter monitored to assess therapeutic efficacy and make dose adjustments?
- a. Free T4
- b. Total T3
- c. TSH
- d. Complete Blood Count (CBC)
Answer: c. TSH
14. Myxedema coma is a life-threatening emergency caused by:
- a. Severe, decompensated hyperthyroidism.
- b. Severe, decompensated hypothyroidism.
- c. An overdose of levothyroxine.
- d. An overdose of methimazole.
Answer: b. Severe, decompensated hypothyroidism.
15. In addition to inhibiting thyroid hormone synthesis, what other mechanism of action does propylthiouracil (PTU) have that methimazole does not?
- a. It inhibits the release of TSH.
- b. It blocks the peripheral conversion of T4 to T3.
- c. It destroys the thyroid gland.
- d. It is a beta-blocker.
Answer: b. It blocks the peripheral conversion of T4 to T3.
16. The pharmacology of antiarrhythmics like amiodarone, which can cause thyroid dysfunction, is covered in the Patient Care 3 curriculum.
- a. True
- b. False
Answer: a. True
17. Thyroid storm is a life-threatening emergency caused by:
- a. Severe hypothyroidism
- b. Severe hyperthyroidism (thyrotoxicosis)
- c. Iodine deficiency
- d. A pituitary tumor
Answer: b. Severe hyperthyroidism (thyrotoxicosis)
18. Which medication can cause both hypothyroidism and hyperthyroidism due to its high iodine content and effects on thyroid hormone metabolism?
- a. Lithium
- b. Amiodarone
- c. Metformin
- d. Lisinopril
Answer: b. Amiodarone
19. Why must levothyroxine be separated from supplements like calcium carbonate and iron sulfate?
- a. The supplements increase the absorption of levothyroxine.
- b. The supplements can chelate with levothyroxine and decrease its absorption.
- c. The combination increases the risk of hyperthyroidism.
- d. The combination is toxic to the liver.
Answer: b. The supplements can chelate with levothyroxine and decrease its absorption.
20. An active learning session on thyroid disorders is part of the Patient Care 5 course.
- a. True
- b. False
Answer: a. True
21. Which thionamide is generally preferred for treating hyperthyroidism in most cases, except for the first trimester of pregnancy?
- a. Propylthiouracil (PTU)
- b. Methimazole
- c. Both are equally preferred.
- d. Neither is a first-line agent.
Answer: b. Methimazole
22. Propylthiouracil (PTU) carries a black box warning for:
- a. Severe liver injury.
- b. Agranulocytosis.
- c. QTc prolongation.
- d. Lactic acidosis.
Answer: a. Severe liver injury.
23. The pathophysiology of Graves’ disease involves:
- a. Autoimmune destruction of the thyroid gland.
- b. A “hot” nodule that overproduces thyroid hormone.
- c. Autoantibodies that stimulate the TSH receptor, leading to overproduction of thyroid hormone.
- d. A lack of iodine in the diet.
Answer: c. Autoantibodies that stimulate the TSH receptor, leading to overproduction of thyroid hormone.
24. An active learning session on endocrinology is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
25. A patient with hypothyroidism is started on levothyroxine. How long should they wait before having their TSH rechecked for a dose adjustment?
- a. 1 week
- b. 2 weeks
- c. 4-6 weeks
- d. 3 months
Answer: c. 4-6 weeks
26. Exophthalmos (bulging eyes) is a characteristic sign of which thyroid disorder?
- a. Hashimoto’s thyroiditis
- b. A toxic adenoma
- c. Graves’ disease
- d. Subacute thyroiditis
Answer: c. Graves’ disease
27. What is the role of radioactive iodine (RAI; I-131) in the management of hyperthyroidism?
- a. It is used to control symptoms like tachycardia.
- b. It is an antithyroid drug that blocks hormone synthesis.
- c. It is taken up by the thyroid gland and destroys the tissue, providing a definitive cure.
- d. It is used to diagnose the cause of hyperthyroidism.
Answer: c. It is taken up by the thyroid gland and destroys the tissue, providing a definitive cure.
28. An active learning session on thyroid disorders is part of which course module?
- a. Module 2: Endocrinology
- b. Module 3: Women’s Health
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 2: Endocrinology
29. The initial starting dose of levothyroxine in an elderly patient with cardiovascular disease should be:
- a. The full anticipated replacement dose.
- b. Higher than a typical adult starting dose.
- c. A low dose (e.g., 12.5-25 mcg) with slow titration.
- d. Based on their T3 level.
Answer: c. A low dose (e.g., 12.5-25 mcg) with slow titration.
30. The “Management of Thyroid Gland Disorders” is a lecture within the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
31. In the management of thyroid storm, potassium iodide solution (SSKI) is given. What is its mechanism?
- a. It blocks the synthesis of thyroid hormone.
- b. It destroys the thyroid gland.
- c. It acutely blocks the release of pre-formed thyroid hormone from the gland (Wolff-Chaikoff effect).
- d. It controls the patient’s heart rate.
Answer: c. It acutely blocks the release of pre-formed thyroid hormone from the gland (Wolff-Chaikoff effect).
32. When treating thyroid storm, when should SSKI be administered?
- a. Immediately upon diagnosis.
- b. At least one hour after a thionamide (like PTU) has been given.
- c. It is given as an IV infusion.
- d. At the same time as the beta-blocker.
Answer: b. At least one hour after a thionamide (like PTU) has been given.
33. Levothyroxine has a narrow therapeutic index. This means that:
- a. It is a very safe drug with a wide dosing range.
- b. Small changes in dose or absorption can lead to significant changes in therapeutic effect or toxicity.
- c. It has very few side effects.
- d. It can be interchanged freely between different manufacturers.
Answer: b. Small changes in dose or absorption can lead to significant changes in therapeutic effect or toxicity.
34. The primary role of the pharmacist in managing thyroid disease is:
- a. To diagnose the condition.
- b. To perform thyroid surgery.
- c. To ensure appropriate dosing, monitor for efficacy and toxicity, and counsel on proper administration.
- d. To order and interpret radioactive iodine uptake scans.
Answer: c. To ensure appropriate dosing, monitor for efficacy and toxicity, and counsel on proper administration.
35. Agranulocytosis is a rare but serious side effect of which class of medications?
- a. Beta-blockers
- b. Thionamides (methimazole, PTU)
- c. Thyroid hormones (levothyroxine)
- d. Iodides
Answer: b. Thionamides (methimazole, PTU)
36. A patient taking levothyroxine who experiences palpitations, anxiety, and weight loss may be:
- a. Experiencing side effects of the drug at a therapeutic dose.
- b. On a dose that is too low (undertreated hypothyroidism).
- c. On a dose that is too high (iatrogenic hyperthyroidism).
- d. Having an allergic reaction.
Answer: c. On a dose that is too high (iatrogenic hyperthyroidism).
37. Which statement about desiccated thyroid extract (e.g., Armour Thyroid) is true?
- a. It is the recommended first-line treatment for hypothyroidism.
- b. It contains a fixed, physiologic ratio of T4 to T3.
- c. It is not generally recommended due to variability in hormone content and a non-physiologic T4:T3 ratio.
- d. It is a synthetic product.
Answer: c. It is not generally recommended due to variability in hormone content and a non-physiologic T4:T3 ratio.
38. The “Intro to Thyroid Gland” is a lecture in the Patient Care 5 curriculum.
- a. True
- b. False
Answer: a. True
39. Which of the following drugs can increase the clearance of levothyroxine, potentially requiring a dose increase?
- a. Amiodarone
- b. Phenytoin, carbamazepine
- c. A proton pump inhibitor
- d. A calcium supplement
Answer: b. Phenytoin, carbamazepine
40. An active learning session covering thyroid disorders is part of which course?
- a. PHA5787C Patient Care 5
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5787C Patient Care 5
41. The hormone T3 is more potent than T4, but T4 has a longer half-life.
- a. True
- b. False
Answer: a. True
42. A patient with subclinical hypothyroidism (high TSH, normal free T4) should always be treated with levothyroxine.
- a. True
- b. False
Answer: b. False
43. A goiter refers to:
- a. Bulging of the eyes.
- b. An enlargement of the thyroid gland.
- c. A rapid heart rate.
- d. A type of thyroid cancer.
Answer: b. An enlargement of the thyroid gland.
44. What is the role of iodine in thyroid physiology?
- a. It is a necessary component for the synthesis of thyroid hormones.
- b. It inhibits the release of TSH.
- c. It stimulates the conversion of T4 to T3.
- d. It has no role in thyroid function.
Answer: a. It is a necessary component for the synthesis of thyroid hormones.
45. A patient should be counseled to take their levothyroxine at the same time every day, preferably:
- a. In the morning.
- b. In the evening.
- c. With other medications.
- d. The consistency is more important than the specific time of day, as long as it’s separated from interfering substances.
Answer: d. The consistency is more important than the specific time of day, as long as it’s separated from interfering substances.
46. In Graves’ disease, TSH levels are low because:
- a. The pituitary gland is not functioning.
- b. The hypothalamus is not functioning.
- c. High levels of T4 and T3 provide strong negative feedback to the pituitary.
- d. The TSH receptor antibodies destroy the pituitary.
Answer: c. High levels of T4 and T3 provide strong negative feedback to the pituitary.
47. A key part of managing thyroid disorders is:
- a. Recognizing that different brands of levothyroxine may not be bioequivalent.
- b. Counseling patients on the lifelong nature of therapy for hypothyroidism.
- c. Identifying drugs that can interfere with thyroid function or levothyroxine absorption.
- d. All of the above.
Answer: d. All of the above.
48. An active learning session on thyroid disorders is part of which course module?
- a. Module 2: Endocrinology
- b. Module 1: Diabetes Mellitus
- c. Module 4: Medication Safety
- d. Module 8: Men’s Health
Answer: a. Module 2: Endocrinology
49. The overall management of thyroid disease requires:
- a. A single dose of a single medication.
- b. A “one-size-fits-all” approach.
- c. An individualized approach based on lab monitoring, clinical symptoms, and patient factors.
- d. Treatment only when the patient has severe symptoms.
Answer: c. An individualized approach based on lab monitoring, clinical symptoms, and patient factors.
50. The ultimate goal of learning about the management of thyroid disorders is to:
- a. Safely and effectively manage pharmacotherapy to restore a euthyroid state and improve patient quality of life.
- b. Be able to interpret a radioactive iodine uptake scan.
- c. Pass the endocrinology exam.
- d. Memorize all the different strengths of levothyroxine.
Answer: a. Safely and effectively manage pharmacotherapy to restore a euthyroid state and improve patient quality of life.