Graves' Disease

Reading for this module should include Chapters 10 and 11 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.

Anticipated study and testing time for this module is 3 hours. 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., with payment of $45. After satisfactory completion of the examination, a certificate will be returned by mail.

1. Graves’ Disease may include:
	A. Thyrotoxicosis
	B. Ophthalmopathy
	C. Pretibial myxedema
	D. A + B + C
	E. Only B

2. Thyrotoxicosis in Graves’ Disease is caused by:
	A. Anti-TPO antibodies
	B. Anti-thyroglobulin antibodies
	C. Thyroid stimulating antibodies (TSAb)
	D. Thyrotrophin binding inhibitory antibodies (TBII)
	E. A + B

3. Characteristic features of thyrotoxicosis include:
	A. Hypermetabolism
	B. Anxiety
	C. Increased cardiac output
	D. Heavy menstrual flow
	E. A + B + C + D

4. Laboratory findings in Graves’ Disease often include:
	A. Increased cholesterol
	B. Elevated alkaline phosphatase
	C. Elevated FT4
	D. Elevated TSH
	E. Positive anti-TPO and TG antibodies

5. Diagnosis of Graves’ Disease is proven by:
	A. Low TSH
	B. Positive antibodies
	C. Elevated T4
	D. A + B + C
	E. None of the above

6. The generally accepted simplest test to document thyrotoxicosis in the clinical context of Graves’ Disease is:
	A. Suppressed TSH
	B. Positive antibodies
	C. Elevated T3
	D. Elevated RT3
	E. A + B + C + D

7. With symptoms of anxiety, tremor, sweating, weight loss, diffuse goiter on palpation, suppressed TSH, and elevated FT4, the differential diagnosis includes:
	A. Only Graves’ Disease
	B. Could be toxic multinodular goiter, but unlikely
	C. Could be single toxic nodule
	D. Could be thyrotoxicosis factitia
	E. Could be TSH producing tumor

8. For a patient with Graves’ disease, age of 12 years, the usual initial therapy is:
	A. Surgery
	B. Antithyroid drug therapy
	C. RAI
	D. Iodide
	E. Propranolol

9. Regarding ¹³¹I therapy of Graves’ Disease in children under age 18, it is:
	A. Considered by all to be too dangerous, as a cause of thyroid cancer and genetic defects
	B. Totally safe for children of any age
	C. Decreasing risk with increasing age, and considered safe after age 18
	D. Considered by some clinicians that risk of RAI may be balanced by risks of surgery
	E. Not shown yet to produce genetic defects in progeny

10. During antithyroid drug therapy:
	A. Rash, if mild, can be watched carefully during antihistamine treatment
	B. Fever or arthritis require cessation of drug, or switch to an alternate antithyroid drug therapy
	C. Reacting to one antithyroid drug always means reaction to the other will occur
	D. Neutropenia < 1200/mm³ requires cessation of antithyroid drug treatment
	E. Neutropenia < 1200/mm³ requires a switch to the alternate antithyroid drug

11. ¹³¹RAI therapy of thyrotoxicosis:
	A. Requires RAI uptake pre-treatment
	B. Can be given during KI therapy
	C. Never induces hypothyroidism
	D. Is considered by many (but not proven) to exacerbate ophthalmopathy
	E. A + B + C + D are correct

12. Ideal preparation for surgical treatment of thyrotoxicosis includes:
	A. Antithyroid drug therapy until euthyroid
	B. KI only
	C. Propranolol 10 qid
	D. Antithyroid drug followed by KI (or T4) therapy pre-operatively
	E. A + B + C + D are correct

13. The most common treatment of Graves’ Disease in adults in the United States is:
	A. RAI
	B. Surgery
	C. Antithyroid drug therapy
	D. KI
	E. Propranolol

14. RAI therapy of Graves’ Disease:
	A. Cannot be used before child bearing
	B. Can be given to young men but not to young women
	C. Creates whole body radiation exposure similar to natural background exposure by age 30
	D. Has been shown to produce congenital defects in progeny
	E. Would double natural birth defects from 4% to 8%.

15. The clinical course after RAI therapy of thyrotoxicosis may include:
	A. Suppressed TSH for 1 – 6 months, even if T4 is normal
	B. Worsened thyrotoxicosis
	C. Worsened eye problems
	D. Rapid hypothyroidism
	E. A + B + C + D

Answer Sheet
Enter "True" or "False" in the appropriate boxes.
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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 -- CAUSE, COURSE AND TREATMENT OF GRAVES’ DISEASE PREPARED BY LESLIE J. DE GROOT,MD BACK

CME QUESTIONS -- CAUSE, COURSE AND TREATMENT OF GRAVES’ DISEASE
PREPARED BY LESLIE J. DE GROOT,MD BACK