Hall: Guyton and Hall Textbook of Medical Physiology, 12th Edition
Chapter 76: Thyroid Metabolic Hormones
Test Bank
1. A patient has a goiter associated with high plasma levels of both TRH and TSH. Heart
rate is elevated. This patient most likely has which of the following?
A. Endemic goiter
B. A hypothalamic tumor secreting large amounts of TRH
C. A pituitary tumor secreting large amounts of TSH
D. Graves’ disease
E. A thyroid adenoma
2. A 30-year-old female reports to the clinic for a routine physical examination. The
examination reveals that she is pregnant. Plasma levels of TSH are high but total thyroid
hormone concentration is normal. Which of the following best reflects this patient’s
clinical state?
A. Graves’ disease
B. Hashimoto’s disease
C. A pituitary tumor secreting TSH
D. A hypothalamic tumor secreting TRH
E. The patient is taking thyroid extract
3. A patient has the following: elevated [plasma T4], low [plasma TSH], and a thyroid
gland size below normal. Which of the following is the most likely explanation for these
finding?
A. A lesion of the anterior pituitary that prevents TSH secretion
B. The patient is taking propylthiouracil
C. The patient is taking thyroid extract
D. The patient is consuming large amounts of iodine
E. Graves’ disease
4. A patient has myxedema. Which of the following sets of physiological changes would be
expected?
Cardiac output Plasma [RT3] Plasma [cholesterol]
A. ↑ ↑ ↑
B. ↑ ↓ ↓
C. ↓ ↑ ↓
D. ↓ ↓ ↑
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E. ↓ ↓ ↓
5. A patient has been completely thyroidectomized for the treatment of thyroid disease and
is given oral thyroxine (T4) for substitution therapy. TSH levels are normal. Which of the
following would be expected?
A. Low plasma levels of T4
B. Low plasma levels of T3
C. High plasma levels of RT3
D. A low rate of thyroglobulin synthesis
E. A low rate of TBG synthesis
6. A 37-year-old woman presents to her physician with an enlarged thyroid gland and high
plasma levels of T4 and T3. Which of the following is likely to be decreased?
A. Heart rate
B. Cardiac output
C. Peripheral vascular resistance
D. Ventilation rate
E. Metabolic rate
7. Administration of an inhibitor of thyroid peroxidase would cause an increase in which of
the following?
A. Thyroid content of iodine
B. Thyroid content of monoiodotyrosine
C. Thyroid content of thyroxine
D. TSH secretion
E. Urinary excretion of diiodotyrosine
8. A chronic increase in the plasma concentration of thyroid-binding globulin would result
in which of the following?
A. An increased delivery of T4 to target cells
B. A decrease in the free T4 level
C. An increase in the conversion of T4 to T3 in peripheral tissues
D. An increase in TSH secretion
E. No change in metabolic rate
9. A woman has puffy skin and is lethargic. Her plasma TSH is low. Which of the following
most likely account for her symptoms?
A. Graves’ disease
B. She is taking thyroid extract
C. Endemic goiter
D. Chronic Hashimoto’s disease
E. Pituitary failure
10. A patient has a pituitary tumor that secretes large amounts of TSH. Which of the
following would you least expect?
A. High plasma levels of T4
B. High plasma levels of T3
C. Exophthalmos
D. Increased respiratory rate
E. Goiter
11. A patient has hyperthyroidism due to a pituitary tumor. Which of the following sets of
physiological changes would be expected?
Thyroglobulin Synthesis Heart Rate Exopthalomos
A. ↑ ↑ +
B. ↑ ↑ –
C. ↑ ↓ +
D. ↓ ↓ +
E. ↓ ↓ –
F. ↓ ↑ –
12. Mr. Smith has been diagnosed with pronounced nephrosis. He does not have a goiter but
is feeling more tired than normal. However, you suspect he is euthyroid and order a
blood sample. If he is euthyroid, which of the following would be expected?
Total Plasma T4 Plasma TSH
A. ↓ ↑
B. ↓ ↔
C. ↓ ↓
D. ↔ ↑
E. ↔ ↔
F. ↔ ↓
13. A patient has a goiter associated with high plasma levels of both TRH and TSH. Heart
rate is elevated. The patient most likely has:
A. Endemic goiter
B. A hypothalamic tumor secreting large amounts of TRH
C. A pituitary tumor secreting large amounts of TSH
D. Graves’ disease
14. Which of the following regarding T4 is false?
A. Secretion rate from thyroid exceeds that of T3
B. Secretion rate from thyroid is decreased by propylthiouracil
C. Plasma concentration is less than that of T3
D. Peripheral deiodination is the major source of circulating T3
15. A pregnant patient has a normal hypothalamo-hypophysial axis. A blood sample reveals
elevations in the concentrations of thyroxine-binding globulin and total thyroid
hormones, and low plasma TSH concentration. Assuming steady state conditions one
would expect:
A. Graves’ disease
B. Hypothyroidism
C. Euthyroidism
D. High plasma levels of thyrotropin releasing hormone
16. A patient has a goiter and exhibits sweating and tachycardia. Plasma levels of TSH are
elevated but plasma levels of thyrotropin releasing hormone are reduced. This patient
probably has:
A. Graves’ disease
B. Hyperthyroidism due to a primary abnormality in the pituitary gland
C. Hyperthyroidism due to a primary abnormality in the hypothalamus
D. Hypothyroidism due to an abnormality in the thyroid gland
17. A patient has a pronounced goiter associated with increased plasma levels of TSH. The
patient complains of constipation and lethargy. Which of the following is the most likely
explanation for these findings?
A. The patient is taking thyroid extract
B. The patient is taking propylthiouracil
C. The patient is consuming large amounts of iodine
D. The patient has a pituitary adenoma
E. The patient has Graves’ disease
Test Bank
76-5
18. Which of the following would be expected in a patient with a deficiency in iodine?
A. Weight loss
B. Nervousness
C. Increased sweating
D. Increased synthesis of thyroglobulin
E. Tachycardia