Graves' Complications

Reading for this module should include Chapters 12 in Thyroid Disease Manager, or alternative sources. These could include chapters 41 and 42 in Endocrinology, Edition III, comparable chapters in Endocrinology Edition IV (when released), or appropriate chapters in “The Thyroid”. Please note that many questions have more than one correct answer among the multiple possible responses offered.

After reading the material, print out his page, complete the test, fill in required personal information, and send the page with payment to

Center for Continuing Medical Education, 950 E 61^st St., University of Chicago, Chicago, IL 60637. Anticipated study and testing time for this module is 2 hours, and payment is $30. After satisfactory completion of the examination, a certificate will be returned by mail.

I. What is true in thyroid storm?
	A. Often occurs in winter.
	B. Therapeutic administration of iodine is contra-indicated in this situation.
	C. Therapeutic administration of propranolol is contra-indicated in this situation.
	D. Has a mortality rate of >30%, despite prompt recognition and treatment.
	E. None of these

II. What is true in Thyroid Eye Disease:
	A. May occur without hyperthyroidism.
	B. May occur in apparent Hashimoto's disease.
	C. Is not excluded in patients with multinodular goiter.
	D. May lead to blindness.
	E. Is rarely one-sided.

III. In the pathophysiology of Thyroid Eye Disease, the following factors are probably of importance.
	A. Activity of T lymphocytes.
	B. The presence of TSH-receptor transcripts in retro-orbital tissues.
	C. Family history of the disease.
	D. Proliferation of fibroblasts.
	E. Production of glycoaminoglycans.

IV. Current common practice for treatment of active, non-malignant, Thyroid Eye Disease may involve:
	A. Primary orbital decompression.
	B. Systemic administration of corticosteroids
	C. Orbital irradiation.
	D. Control of hyperthyroidism.

V. The following treatment modalities of Thyroid Eye disease have been reported but as of now are still unproven.
	A. Plasmapheresis.
	B. Administration of cyclophosphamide
	C. Administration of azathioprine.
	D. Treatment with somatostatin.
	E. Intravenous administration of gamma-globulins.

VI. The following manifestations can be seen in auto-immune thyroid disease.
	A. Localized myxedema.
	B. Enlarged thymus.
	C. Patchy vitiligo.
	D. Enlarged spleen.
	E. Loss of hair.

VII. What is probably true in the pathogenesis of localized myxedema?
	A. Production of glycoaminoglycans.
	B. Tissue hypothyroidism.
	C. Effects of TSH-receptor antibodies.
	D. Local presence of mutated TSH-receptor transcripts.
	E. Local stimulation of fibroblasts.

VIII. Acropachy can be radiologically be distinguished from:
	A. Osteoarthritis.
	B. Rheumatoid arthritis.
	C. Psoriatic arthritis.
	D. Osteoarthropathy associated with pulmonary disease.
	E. All of these.

IX. Heart abnormalities in thyrotoxicosis:
	A. Occur both in patients with multinodular goiter and in Graves' disease.
	B. Include an increased cardiac output.
	C. Include congestive heart failure.
	D. Increased prevalence of mitral prolaps.
	E. All of these.

X. The following arrythmias and conduction disturbancies occur more frequently in the thyrotoxic heart:
	A. W.P.W syndrome
	B. Atrial-ventricular conduction block.
	C. Multi-focal premature beats.
	D. Uni-focal premature beats.
	E. Atrial rhythm (shifting or wandering pacemaker).

Answer Sheet
Enter "True" or "False" in the appropriate boxes.
	A (True/False)	B (True/False)	C (True/False)	D (True/False)	E (True/False)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Was there a topic not covered you would have liked to have had presented? Please specify.

Do you believe the presentations contained pharmaceutical industry bias? Yes __ No __ Comments:

I certify that I spent three hours in preparation and examination for this module-

CME QUESTIONS—COMPLICATIONS OF GRAVES’ DISEASE PREPARED BY GEORG HENNEMANN, MD BACK

CME QUESTIONS—COMPLICATIONS OF GRAVES’ DISEASE
PREPARED BY GEORG HENNEMANN, MD BACK