1. A 40-year-old woman is newly diagnosed with hypothyroidism. She is reluctant to start levothyroxine. Her serum TSH is 8 (normal 0.5-5). She has fatigue but no other symptoms. Which counselling point is most appropriate?

• Without treatment, she risks cardiovascular death
• Untreated disease leads to infertility
• Neurocognitive decline occurs with prolonged disease
• Cosmetic puffiness will continue without therapy

2. A 56-year-old man underwent total thyroidectomy for follicular thyroid carcinoma two years ago. He received radioactive iodine with successful ablation. Surveillance thyroglobulin levels have been undetectable, and ultrasound shows no evidence of disease. How often should thyroglobulin levels be monitored?

• Annually
• Every six months
• Every 3-5 years
• No further monitoring is needed

3. A 21-year-old woman has a solitary 2.5 cm hypoechoic solid thyroid nodule on ultrasound, along with palpable cervical lymphadenopathy. FNA of the lymph node reveals thyroid tissue. What is the most likely diagnosis?

• Follicular thyroid carcinoma
• Papillary thyroid carcinoma
• Multinodular goiter
• Hashimoto’s thyroiditis

4. A 66-year-old woman underwent thyroidectomy five years ago for an indeterminate thyroid nodule. She has been lost to follow-up since then. On checking, her serum TSH was found to be 24. She complains only of some mild memory problems. What medication should be started?

• Levothyroxine 75 mcg daily
• Levothyroxine 300 mcg weekly
• Liothyronine 20 mcg daily
• Levothyroxine 50 mcg daily

5. A 59-year-old man receives radioactive iodine therapy for Graves’ disease, resulting in iatrogenic hypothyroidism. His serum TSH becomes elevated at 14. He feels well, but routine ECG shows flattened T waves. What intervention is indicated?

• Increase levothyroxine dose
• Decrease levothyroxine dose
• Repeat ECG in 6 months
• Start liothyronine therapy