skip to main content

Treatment-induced adrenal insufficiency — SCE Endocrinology MCQ

Instant feedback + full explanation. One question, done properly.

HardAdrenalTreatment-induced adrenal insufficiencySCE Endocrinology

A patient received total thyroidectomy and radioiodine for differentiated thyroid carcinoma. At 10 months, neck ultrasound is normal, stimulated thyroglobulin is undetectable and antibodies are negative. TSH is currently below 0.05 mIU/L. What long-term target is appropriate under NICE dynamic risk stratification?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Relax levothyroxine suppression to a TSH target of 0.3–2.0 mIU/L

Explanation lettering: E = shown as B · D = shown as C · C = shown as D · B = shown as E

B is correct. NICE recommends reassessing response at 9–12 months. An excellent structural and biochemical response permits relaxation to a TSH of 0.3–2.0 mIU/L, reducing atrial and skeletal harm from unnecessary chronic suppression. Persistent suppression below 0.01 is reserved for ongoing high-risk disease, not this response. Thyroid hormone cannot be stopped after total thyroidectomy. A high-normal target is not the stated range, and liothyronine with undetectable free T4 is not a surveillance strategy.

Reference: NICE NG230 thyroid cancer recommendations: https://www.nice.org.uk/guidance/NG230/chapter/Recommendations