Thyroid Emergencies Practice Questions

25 multiple-choice questions on Thyroid emergencies for paramedic and EMT students, from Chapter 24 (Endocrine Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A patient with untreated hyperthyroidism receives IV iodinated contrast for a CT scan. This may:

   1. A. Cure the hyperthyroidism
   2. B. Trigger thyroid storm
   3. C. Cause hypoglycemia
   4. D. Lower the heart rate
   Show answer

   Answer: B. Trigger thyroid storm

   A large iodine load can increase hormone production in an overactive gland (Jod-Basedow effect) and precipitate thyroid storm. Other triggers include surgery, infection, and stopping antithyroid drugs.

2. The most common cause of hyperthyroidism is:

   1. A. Hashimoto thyroiditis
   2. B. Iodine deficiency
   3. C. Graves disease
   4. D. Pituitary failure
   Show answer

   Answer: C. Graves disease

   Graves disease is an autoimmune condition in which antibodies stimulate the thyroid. It may cause bulging eyes.

3. In thyroid storm, the hospital usually gives a beta blocker plus a drug that:

   1. A. Raises thyroid hormone levels
   2. B. Replaces lost thyroid tissue
   3. C. Speeds up the heart rate
   4. D. Blocks new hormone production
   Show answer

   Answer: D. Blocks new hormone production

   Treatment combines a beta blocker for adrenergic symptoms with a thionamide (propylthiouracil or methimazole) to block hormone synthesis, then iodine and steroids. Supportive cooling and fluids continue.

4. A patient with Graves disease who stopped her antithyroid medicine is most at risk of thyroid storm when she:

   1. A. Eats a high-fiber diet
   2. B. Sleeps more than usual
   3. C. Gets an infection or has surgery
   4. D. Takes a vitamin B supplement daily
   Show answer

   Answer: C. Gets an infection or has surgery

   Thyroid storm is usually triggered by a stressor such as infection, surgery, trauma, childbirth, or stopping antithyroid drugs in a patient with hyperthyroidism.

5. A young man with untreated hyperthyroidism wakes with severe leg weakness after a large carbohydrate meal. A likely cause is:

   1. A. Low potassium paralysis
   2. B. A spinal cord stroke
   3. C. Guillain-Barre syndrome
   4. D. Alcohol withdrawal
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   Answer: A. Low potassium paralysis

   Thyrotoxic periodic paralysis, most common in young men of Asian descent, causes sudden weakness from potassium shifting into cells, often after carbohydrates or rest after exercise. It can cause dysrhythmias.

6. Which arrhythmia is common in thyroid storm?

   1. A. Sinus bradycardia
   2. B. Atrial fibrillation
   3. C. Third-degree heart block
   4. D. Asystole
   Show answer

   Answer: B. Atrial fibrillation

   Excess thyroid hormone increases heart rate and can cause rapid atrial fibrillation.

7. A woman taking methimazole for Graves disease has a high fever and a severe sore throat. Your main concern is:

   1. A. A normal cold
   2. B. Too much thyroid hormone
   3. C. An allergy to her throat lozenges, nothing more
   4. D. A dangerously low white cell count
   Show answer

   Answer: D. A dangerously low white cell count

   Antithyroid drugs can cause agranulocytosis, a rare but life-threatening drop in neutrophils that presents with fever and sore throat. The drug is stopped and a blood count checked urgently.

8. For fever control in thyroid storm, aspirin should be avoided because it:

   1. A. Frees more thyroid hormone
   2. B. Often causes hypoglycemia
   3. C. Raises the blood pressure
   4. D. Slows the heart rate too much
   Show answer

   Answer: A. Frees more thyroid hormone

   Aspirin displaces thyroid hormone from binding proteins, increasing active hormone. Use cooling and acetaminophen per protocol.

9. The most common cause of hypothyroidism in the United States is:

   1. A. Iodine deficiency
   2. B. Thyroid cancer
   3. C. A tumor of the pituitary gland
   4. D. Hashimoto thyroiditis
   Show answer

   Answer: D. Hashimoto thyroiditis

   In iodine-sufficient countries, autoimmune Hashimoto thyroiditis is the leading cause of hypothyroidism. Worldwide, iodine deficiency remains common.

10. Myxedema coma is:

    1. A. A rash from thyroid medication
    2. B. Severe hypothyroidism
    3. C. A rapidly growing thyroid tumor
    4. D. A severe form of thyroid storm
    Show answer

    Answer: B. Severe hypothyroidism

    This rare emergency causes hypothermia, bradycardia, hypoventilation, and coma.

11. Which patient is at highest risk for myxedema coma?

    1. A. A teen with Graves disease
    2. B. A young man after a long run
    3. C. An older woman, untreated
    4. D. A child with a common cold
    Show answer

    Answer: C. An older woman, untreated

    Older women, especially in winter or with infection, are most at risk.

12. Severe hypothyroidism can cause which cardiac finding?

    1. A. A very fast heart rate
    2. B. Atrial flutter waves
    3. C. A ventricular septal defect
    4. D. A pericardial effusion
    Show answer

    Answer: D. A pericardial effusion

    Hypothyroidism can cause fluid to collect around the heart, along with bradycardia and low-voltage ECG complexes. Large effusions can cause hypotension.

13. Patients with myxedema coma may also have:

    1. A. Hyperglycemia and hypernatremia
    2. B. Hypoglycemia and hyponatremia
    3. C. High calcium
    4. D. High potassium only
    Show answer

    Answer: B. Hypoglycemia and hyponatremia

    Slowed metabolism and fluid retention lead to low glucose and low sodium.

14. Prehospital treatment of myxedema coma focuses on:

    1. A. Airway, warming, glucose
    2. B. Rapid active cooling with ice
    3. C. IV beta blockers
    4. D. High-dose aspirin for fever
    Show answer

    Answer: A. Airway, warming, glucose

    Support breathing, rewarm passively, check glucose, and transport.

15. A goiter is:

    1. A. A malignant thyroid tumor
    2. B. An inflamed parathyroid
    3. C. An enlarged thyroid gland
    4. D. A swollen lymph node
    Show answer

    Answer: C. An enlarged thyroid gland

    Goiters can occur with hyperthyroidism, hypothyroidism, or iodine deficiency.

16. A large goiter is concerning in the field because it may:

    1. A. Cause hypoglycemia
    2. B. Compress the airway
    3. C. Cause kidney stones
    4. D. Lower blood pressure
    Show answer

    Answer: B. Compress the airway

    A large thyroid can narrow the trachea, making airway management difficult.

17. Untreated hyperthyroidism over time can lead to:

    1. A. Low blood pressure from slow heart
    2. B. Permanent weight gain
    3. C. Thickened bones
    4. D. High-output heart failure
    Show answer

    Answer: D. High-output heart failure

    Persistent tachycardia, increased cardiac output, and atrial fibrillation can lead to heart failure in hyperthyroidism, especially in older adults. Long-term excess thyroid hormone also thins bone.

18. Levothyroxine is used to treat:

    1. A. Hyperthyroidism
    2. B. Diabetes
    3. C. Hypothyroidism
    4. D. Adrenal crisis
    Show answer

    Answer: C. Hypothyroidism

    Levothyroxine replaces missing thyroid hormone. Too much can cause hyperthyroid symptoms.

19. An overdose of thyroid hormone medication can cause:

    1. A. Tachycardia and agitation
    2. B. Bradycardia and hypothermia
    3. C. Hypoglycemia only
    4. D. Constipation only
    Show answer

    Answer: A. Tachycardia and agitation

    Excess thyroid hormone mimics hyperthyroidism.

20. A few hours after thyroid surgery, a patient has a swelling neck and stridor. The priority is:

    1. A. Giving calcium for low calcium
    2. B. Airway; blood may compress it
    3. C. Letting her rest flat
    4. D. A pain medication only
    Show answer

    Answer: B. Airway; blood may compress it

    A neck hematoma after thyroidectomy can compress the airway rapidly. Treat as an airway emergency, prepare for difficult airway management, and transport fast; surgeons may need to open the wound.

21. Which feature most helps differentiate thyroid storm from sepsis?

    1. A. A known history of thyroid disease
    2. B. A temperature higher than 40 C (104 F)
    3. C. A heart rate faster than 140 beats/min
    4. D. Agitation, confusion, or delirium
    Show answer

    Answer: A. A known history of thyroid disease

    Thyroid storm and sepsis both cause high fever, marked tachycardia, and altered mental status, so those findings alone do not separate them. A known history of thyroid disease, a goiter, or recently stopped thyroid medication points toward thyroid storm. A temperature over 40 C occurs in both. A heart rate over 140 occurs in both. Agitation, confusion, and delirium occur in both.

22. After thyroid surgery, a patient has a hoarse, weak voice. A likely cause is:

    1. A. Low blood glucose
    2. B. A normal cold
    3. C. Too much thyroid hormone given
    4. D. Injury to a laryngeal nerve
    Show answer

    Answer: D. Injury to a laryngeal nerve

    The recurrent laryngeal nerves run beside the thyroid. Injury causes hoarseness, and injury to both sides can cause stridor and airway obstruction.

23. Besides thyroid storm, which condition commonly causes fever, tachycardia, and agitation?

    1. A. Hypothyroidism
    2. B. Myxedema coma
    3. C. Stimulant drug toxicity
    4. D. Adrenal insufficiency (Addison)
    Show answer

    Answer: C. Stimulant drug toxicity

    Cocaine, amphetamines, and other stimulants can mimic thyroid storm with fever, agitation, tachycardia, and hypertension. Drug history and thyroid history help separate them.

24. Why may sedatives be dangerous in hypothyroid patients?

    1. A. They depress breathing
    2. B. They cause hyperthermia
    3. C. They speed the heart rate
    4. D. They raise blood glucose
    Show answer

    Answer: A. They depress breathing

    Hypothyroid patients clear drugs slowly and already breathe slowly.

25. Hypothyroidism can cause which change in the voice?

    1. A. A high-pitched voice
    2. B. Rapid, pressured speech
    3. C. Hoarseness
    4. D. Stuttering
    Show answer

    Answer: C. Hoarseness

    Swelling of the vocal cords can cause hoarseness.