Thyroid Disorders

Question 1

Which set of thyroid function tests is most consistent with hyperthyroidism? A. Low T3 low T4 high TSH B. High T3 high T4 low TSH C. Normal T3 normal T4 high TSH D. High TSH only E. Low TSH with normal T4

Answer 1

B. Hyperthyroidism causes raised T3 and T4 with suppressed TSH due to negative feedback.

Question 2

Which symptom profile is most typical of hyperthyroidism? A. Weight gain constipation cold intolerance B. Depression dry skin bradycardia C. Anxiety diarrhoea heat intolerance D. Fatigue menorrhagia hyponatraemia E. Hair loss hoarse voice oedema

Answer 2

C. Hyperthyroidism is a high metabolic state causing anxiety diarrhoea weight loss palpitations and heat intolerance.

Question 3

What is the first-line drug treatment for hyperthyroidism in the UK? A. Levothyroxine B. Propylthiouracil C. Carbimazole D. Radioactive iodine E. Propranolol

Answer 3

C. Carbimazole is first-line for most patients with hyperthyroidism.

Question 4

A woman of childbearing age is started on carbimazole. What advice must be given? A. Avoid NSAIDs B. Use effective contraception C. Take folic acid D. Avoid alcohol E. Stop after 6 months

Answer 4

B. Carbimazole is associated with congenital malformations so contraception advice is required.

Question 5

A patient on carbimazole develops acute pancreatitis. What is the correct action? A. Reduce dose B. Switch temporarily to PTU C. Continue and monitor D. Stop immediately and permanently E. Add beta blocker

Answer 5

D. Acute pancreatitis is an MHRA red flag requiring permanent cessation.

Question 6

A patient on carbimazole develops fever and sore throat. What is the concern? A. Thyroid storm B. Liver failure C. Bone marrow suppression D. Drug allergy E. Disease relapse

Answer 6

C. Fever and sore throat suggest agranulocytosis; stop immediately and report.

Question 7

Which antithyroid drug is contraindicated in liver disease? A. Carbimazole B. Levothyroxine C. Propranolol D. Propylthiouracil E. Radioactive iodine

Answer 7

D. Propylthiouracil is hepatotoxic; watch for jaundice dark urine and nausea.

Question 8

What is the main role of beta blockers in hyperthyroidism? A. Reduce hormone synthesis B. Induce remission C. Symptomatic relief D. Shrink goitre E. Prevent relapse

Answer 8

C. Beta blockers control symptoms such as palpitations and tremor.

Question 9

What is the first-line definitive treatment for Graves’ disease? A. Carbimazole B. Levothyroxine C. Radioactive iodine D. Surgery E. Propranolol

Answer 9

C. Radioactive iodine is first-line definitive therapy for Graves’.

Question 10

What does block-and-replace therapy involve? A. Radioiodine then levothyroxine B. Carbimazole plus levothyroxine C. PTU plus beta blocker D. Surgery then carbimazole E. Levothyroxine alone

Answer 10

B. Carbimazole blocks hormone production while levothyroxine replaces it for 12–18 months.

Question 11

A woman plans pregnancy within 6 months and needs antithyroid treatment. What is preferred? A. Carbimazole B. Radioactive iodine C. Levothyroxine D. Propylthiouracil E. Surgery

Answer 11

D. PTU is preferred when pregnancy is planned soon.

Question 12

After radioactive iodine treatment when should pregnancy be avoided in women? A. 1 month B. 3 months C. 6 months D. 12 months E. 24 months

Answer 12

C. Women should avoid pregnancy for 6 months after radioactive iodine.

Question 13

Which TFT pattern indicates hypothyroidism? A. High T3 low TSH B. Low T3 low T4 high TSH C. Normal T4 low TSH D. High TSH only E. Low TSH low T4

Answer 13

B. Hypothyroidism causes low T3 and T4 with raised TSH.

Question 14

Which symptom cluster suggests hypothyroidism? A. Weight loss diarrhoea anxiety B. Heat intolerance tremor palpitations C. Weight gain constipation cold intolerance D. Fever night sweats weight loss E. Polyuria polydipsia fatigue

Answer 14

C. Hypothyroidism is a low metabolic state.

Question 15

What is first-line treatment for hypothyroidism? A. Liothyronine B. Carbimazole C. Levothyroxine D. Radioactive iodine E. Propranolol

Answer 15

C. Levothyroxine is standard replacement therapy.

Question 16

How should levothyroxine be taken? A. At night with food B. Morning 30 minutes before breakfast C. With calcium D. After coffee E. With antacids

Answer 16

B. Levothyroxine should be taken on an empty stomach before food or caffeine.

Question 17

How often should TSH be monitored after starting levothyroxine? A. Monthly B. Every 3 months until stable C. Every 6 months D. Yearly only E. Only if symptomatic

Answer 17

B. Monitor every 3 months until stable then yearly.

Question 18

Which issue is recognised by the MHRA with levothyroxine? A. Hepatotoxicity B. QT prolongation C. Symptoms when switching brands D. Agranulocytosis E. Pancreatitis

Answer 18

C. Switching brands can cause symptoms in some patients.

Question 19

Which drug reduces levothyroxine absorption and requires a 4-hour gap? A. Paracetamol B. Calcium carbonate C. Metformin D. Ramipril E. Amoxicillin

Answer 19

B. Calcium aluminium and magnesium antacids reduce absorption.

Question 20

Ferrous sulphate should be separated from levothyroxine by how long? A. No gap B. 30 minutes C. 1 hour D. 2 hours E. 6 hours

Answer 20

D. Iron reduces levothyroxine absorption; separate by at least 2 hours.

Question 21

Levothyroxine can reduce the effect of which drug class? A. Antidepressants B. Antihypertensives C. Antidiabetic drugs D. Anticoagulants E. Antipsychotics

Answer 21

C. Levothyroxine can worsen glycaemic control causing hyperglycaemia.

Question 22

Which weight-loss drug interferes with levothyroxine absorption? A. Liraglutide B. Orlistat C. Metformin D. Semaglutide E. Sibutramine

Answer 22

B. Orlistat reduces levothyroxine absorption.

Question 23

Which statement about liothyronine is correct? A. First-line for hypothyroidism B. Routinely prescribed C. Second-line and not routinely used D. Safe in pregnancy E. No interactions

Answer 23

C. Liothyronine is second-line and not routinely used.

Question 24

EXAM TRAP: A patient with hyperthyroidism is very symptomatic. What drug improves symptoms fastest? A. Carbimazole B. Levothyroxine C. Propranolol D. Radioactive iodine E. PTU

Answer 24

C. Beta blockers give rapid symptomatic relief.

Question 25

EXAM TRAP: Which antithyroid drug should be avoided in early pregnancy? A. Propylthiouracil B. Levothyroxine C. Carbimazole D. Propranolol E. None

Answer 25

C. Carbimazole is associated with congenital malformations.

Question 26

EXAM TRAP: Which finding should prompt urgent blood count in a patient on carbimazole? A. Weight loss B. Tremor C. Palpitations D. Sore throat and fever E. Heat intolerance

Answer 26

D. Suggests agranulocytosis.

Question 27

After radioactive iodine treatment how long should men avoid attempting conception? A. 1 month B. 2 months C. 3 months D. 4 months E. 6 months

Answer 27

D. Men should avoid attempting conception for 4 months after radioactive iodine due to radiation effects on sperm.