Multinodular Goiter

Reading for this module should include Chapter 17 in Thyroid Disease Manager, or alternative sources. These could include chapter 46 in Endocrinology, Edition III, comparable chapters in Endocrinology Edition IV (when released), or 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 3 hours, and payment is $45. After satisfactory completion of the examination, a certificate will be returned by mail.

I. The following are true for multinodular goiter:
	A. Thyroid hormone formation often gradually increases.
	B. It carries a substantial risk for thyroid carcinoma.
	C. Thyroid RAI scanning is a useful tool for routine work-up of the condition.
	D. It is often familial.
	E. It occurs more frequently in areas with iodine deficiency.

II. A 60 year old healthy woman has a moderately enlarged biochemically euthyroid multinodular goiter with minimal pressure symptoms on the trachea. Appropriate treatment includes:
	A. No treatment, discharge from follow-up
	B. No treatment, but regular follow-up.
	C. Suggest surgery to the patient.
	D. Suggest RAI treatment to the patient.

III. A 60 year old healthy woman has a moderately enlarged biochemically euthyroid multinodular goiter without pressure symptoms. The goiter is familial. She has been irradiated on the neck in her childhood. Appropriate treatment includes:
	A. Perform fine needle aspiration + cytology from multiple locations.
	B. No treatment, but regular follow-up.
	C. Suggest surgery to the patient.
	D. Suggest RAI treatment to the patient.

IV. A 60 year old apparently healthy woman, showed on routine physical examination a moderately enlarged goiter without pressure symptoms or signs. On laboratory work up serum TSH was suppressed below 0.2uU/ml on multiple occasions. Free T4 and T3 however were within normal range. Appropriate treatment would be:
	A. No treatment, discharge from follow-up.
	B. No treatment, but regular follow-up.
	C. Suggest surgery to the patient.
	D. Suggest RAI treatment to the patient.
	E. Treatment with anti-thyroid drugs.

V. A 60 year old apparently healthy woman complains of moderate pressure symptoms due to a multinodular goiter. Serum TSH is subnormal but still detectable. Free T4 and T3 are within normal range. Appropriate treatment would be:
	A. T4 suppressive therapy.
	B. T3 suppressive therapy.
	C. RAI therapy.
	D. Surgery.

VI. A 60 year old apparently healthy woman has a multinodular goiter that she noted for the last 5 years. She complains of a hoarse voice for the last 4 months. She appears to have a one sided vocal cord paralysis. There are minimal pressure symptoms on the trachea. Serum TSH is normal. She has never been irradiated on the neck. Appropriate treatment would be:
	A. Regular follow-up.
	B. T4 suppressive therapy.
	C. T3 suppressive therapy.
	D. RAI therapy.
	E. Surgery.

VII. What is probably true according to current insights into the pathogenesis of multinodular goiter?
	A. Mutations in the Gs-alpha gene commonly play a role.
	B. Iodine deficiency may play a role.
	C. Mutations in the TSH-receptor gene may play a role.
	D. "Hidden" inherited defects in thyroid hormone synthesis may play a role.
	E. Growth factors may play a role.

VIII. A 16 year old otherwise healthy female has a moderate diffuse goiter, without pressure symptoms and with normal serum TSH. Serum thyroid auto-antibodies, are absent. There is no family history of goiter. Appropriate treatment would be:
	A. No follow-up.
	B. Only follow-up is acceptable.
	C. TSH-suppressive treatment is acceptable.
	D. Surgery.
	E. RAJ treatment.

IX. A 16 year old otherwise healthy female has a moderate diffuse goiter, without pressure symptoms and with normal serum TSH. Serum thyroid auto-antibodies are absent. There is a family history of goiter. Appropriate treatment would be:
	A. No follow-up.
	B. Only follow-up.
	C. TSH-suppressive treatment.
	D. Surgery
	E. RAJ treatment.

X. A 16 year old otherwise healthy female has a moderate diffuse goiter, without pressure symptoms and with normal serum TSH. Serum thyroid auto-antibodies are present. There is no family history of goiter. Appropriate treatment would be:
	A. No follow-up.
	B. Only follow-up.
	C. TSH-suppressive treatment.
	D. Surgery.
	E. RAI treatment.

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 - COURSE AND TREATMENT OF MULITNODULAR GOITER PREPARED BY GEORG HENNEMANN, MD BACK

CME QUESTIONS - COURSE AND TREATMENT OF MULITNODULAR GOITER
PREPARED BY GEORG HENNEMANN, MD BACK