Thyroid nodule workup, TSH result interpretation, and treatment algorithms for hyperthyroidism and hypothyroidism in outpatient practice.
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- A patient has a high TSH and a low free T4. What does this pattern indicate?
- Primary hypothyroidism
- A patient has a low TSH and a high free T4. What does this pattern indicate?
- Overt primary hyperthyroidism
- A patient has a high TSH but a normal free T4. What does this pattern indicate?
- Subclinical hypothyroidism
- A patient has a low TSH but a normal free T4. What does this pattern indicate?
- Subclinical hyperthyroidism
- A patient has both a low TSH and a low free T4. What does this pattern suggest?
- Central (secondary) hypothyroidism, from a pituitary or hypothalamic problem
- What is the best initial screening test for suspected thyroid dysfunction?
- Serum TSH
- Which gland secretes TSH?
- The anterior pituitary gland
- Rising thyroid hormone levels have what effect on TSH secretion?
- They suppress TSH secretion through negative feedback
- What is the approximate normal reference range for serum TSH?
- About 0.4 to 4.0 mIU/L
- How many weeks after a levothyroxine dose change should TSH be rechecked?
- About 6 to 8 weeks
- What is the first test to order when a thyroid nodule is discovered?
- Serum TSH
- In a thyroid nodule workup, if the TSH comes back suppressed, what is the next step?
- A radioactive iodine uptake (RAIU) scan
- In a thyroid nodule workup, if the TSH is normal or elevated, what is the next step?
- Thyroid ultrasound
- What procedure provides the definitive diagnosis for an indeterminate or suspicious thyroid nodule?
- Fine needle aspiration (FNA) biopsy
- Name one ultrasound feature of a thyroid nodule that raises suspicion for malignancy.
- Microcalcifications