Endocrine drugs: levothyroxine in coronary disease: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Endocrine drugs: levothyroxine in coronary disease

Sample item

A 72-year-old man with angina has newly found overt hypothyroidism with TSH 60 mIU/L. Which approach to levothyroxine is correct?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Start with a low dose and increase slowly

Thyroid hormone raises myocardial oxygen demand, so in elderly patients and those with coronary disease levothyroxine is started at a low dose, such as 12.5 to 25 micrograms, and raised every few weeks.

Option by option

  • A. Start the full replacement dose of 1.6 micrograms per kg

    A full dose can precipitate angina and arrhythmia in coronary disease.

  • B. Start liothyronine in high dose for faster effect

    High-dose liothyronine has a fast, strong effect that increases cardiac risk.

  • C. Delay treatment until the angina has resolved

    Untreated hypothyroidism worsens lipids and cardiac function, so delay is not advised.

  • D. Start with a low dose and increase slowly (correct)

    Correct. A low starting dose avoids precipitating angina or infarction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is D, Start with a low dose and increase slowly. Thyroid hormone raises myocardial oxygen demand, so in elderly patients and those with coronary disease levothyroxine is started at a low dose, such as 12.

Why is "Start the full replacement dose of 1.6 micrograms per kg" not the answer?

A full dose can precipitate angina and arrhythmia in coronary disease.

Why is "Start liothyronine in high dose for faster effect" not the answer?

High-dose liothyronine has a fast, strong effect that increases cardiac risk.

Why is "Delay treatment until the angina has resolved" not the answer?

Untreated hypothyroidism worsens lipids and cardiac function, so delay is not advised.

What concept does this question test?

It tests Endocrine drugs: levothyroxine in coronary disease in Pharmacology. 5 to 25 micrograms, and raised every few weeks.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrine drugs: levothyroxine in coronary disease?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.