Hypothalamus → thyroid releasing hormone → pituitary → thyroid stimulating hormone → thyroid → T3 and T4
2. False. there is a negative feedback loop with T3 and T4 on the pituitary. As T3 and T4 go up the pituitary stops making TSH
3. The answer is D
- Methimazole – is used to control hyperthyroidism, but will take days to weeks to work
- Propylthiourcial (PTU) – is used to control hyperthyroidism, but will take days to weeks to work
- Radioactive Iodine is used to ablate the thyroid. This is long term treatment and not something you would do in the ER.
- Propranolol is a beta blocker and the first line for treatment of acute hyperthyroidism or thyroid storm. It will help with managing symptoms but the patient may require long term treatment.
4. The answer is B
- methimazole – not indicated in a nursing mother
- propylthiourcial (PTU) – this is the appropriate medication for a nursing mother
- radioactive Iodine – a nursing mother would not undergo radioactive iodine ablation. This process requires several days of isolation
- propranolol will treat symptoms, but it is not the best choice for long term managment
5. The answer is D
- Heat intolerance
- Weight loss
- Painful cough – it’s hard to come up with something that isn’t a symptom of hyperthyroidism
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