Thyroid Disease: ABFM practice questions

19 board-style questions on thyroid disease in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 48-year-old woman presents with fatigue, mild weight gain, and dry skin over the past 6 months. She has no goiter on exam. Laboratory results show TSH 8.2 mIU/L (normal 0.5-4.5) and free T4 1.0 ng/dL (normal 0.8-1.8). Anti-thyroid peroxidase (anti-TPO) antibodies are elevated at 450 IU/mL. What is the most appropriate diagnosis and management?

1. Overt hypothyroidism; start levothyroxine at full replacement dose
2. Subclinical hypothyroidism with positive anti-TPO; start low-dose levothyroxine and recheck TSH in 6-8 weeks
3. Euthyroid sick syndrome; no treatment needed
4. Central hypothyroidism; order pituitary MRI

Sample question 2

A 32-year-old woman presents with a 3-month history of unintentional weight loss of 15 pounds, palpitations, heat intolerance, and tremor. On examination, she has a diffusely enlarged, nontender thyroid, lid lag, and bilateral proptosis. Heart rate is 108 bpm. Laboratory results show TSH <0.01 mIU/L (normal 0.5-4.5) and free T4 4.8 ng/dL (normal 0.8-1.8). What is the most appropriate next step to confirm the diagnosis?

1. Fine-needle aspiration biopsy
2. CT of the orbits
3. Thyroid ultrasound
4. Thyroid-stimulating immunoglobulin (TSI) or radioactive iodine uptake scan

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