Part A

PPP Reading07

TIME: 15 minutes

• Look at the four texts, A-D, in the separate Text Booklet.

• For each question, 1-20, look through the texts, A-D, to find the relevant information.

• Write your answers in the spaces provided in this Question Paper.

• Answer all the questions within the 15-minute time limit.

• Your answers should be correctly spelt.

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Hypothyroidism: Questions

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Questions 1-7

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For each question, 1-7, decide which text (A, B, C or D) the information comes from. You may use any
letter more than once.
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In which text can you find information about

1 reassurance for patients regarding the impact of their condition?

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2 how younger patients can be treated for hypothyroidism?

3 possible negative responses to treatment for hypothyroidism?

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4 instances when the initial amount of a drug given should be reduced?

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5 who is more likely to suffer from hypothyroidism?

6 avoiding a particular form of a drug?

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7 what patients with hypothyroidism should eat?

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Questions 8-15

Answer each of the questions, 8-15, with a word or short phrase from one of the texts. Each answer may include
words, numbers or both.

8 From what age are women considered to be more likely to develop thyroid problems?

9 In suspected cases of hypothyroidism, what can be checked instead of the free hormone level?

©Cambridge Boxhill Language Assessment Pty Ltd 2020

 PPP Reading07

10 Which thyroid hormone needn’t normally be measured?

11 What characteristic of thyroid hormones means that over-treatment or under-treatment can be harmful?

12 What is sometimes reduced in post-menopausal women if they are prescribed too high a dose of
thyroid hormone?

13 What type of drinks should hypothyroid patients avoid?

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14 What minimum daily dose of levothyroxine sodium should be given to a four-month old patient with

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ut enhypothyroidism?

15 What dose of levothyroxine sodium should be given to a three-year old with hypothyroidism?
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Questions 16-20
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Complete each of the sentences, 16-20, with a word or short phrase from one of the texts. Each answer may
include words, numbers or both.
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16 The recommended diet for patients with hypothyroidism helps them maintain a healthy
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17 Egg yolks contain , which is good for patients.

18 Diabetic patients treated with thyroid hormone may experience

19 Too much thyroid hormone can provoke heart problems for older people and patients already suffering

from

20 A TSH level of 7.5 mIU/L combined with free T4 that is normal is regarded

as hypothyroidism.

END OF PART A
THIS QUESTION PAPER WILL BE COLLECTED

©Cambridge Boxhill Language Assessment Pty Ltd 2020

 Hypothyroidism: Texts
PPP Reading07

Text A

Third-generation thyroid-stimulating hormone (TSH) assays are generally the most sensitive screening tool
for primary hypothyroidism. If TSH levels are above the reference range, the next step is to measure free
thyroxine (T4) or the free thyroxine index (FTI), which serves as a surrogate of the free hormone level.
Routine measurement of triiodothyronine (T3) is not recommended.
Results in patients with hypothyroidism are as follows:
• Elevated TSH with decreased T4 or FTI
• Elevated TSH (usually 4.5-10.0 mIU/L) with normal free T4 or FTI is considered subclinical
hypothyroidism
Abnormalities in the complete blood count and metabolic profile that may be found in patients with
hypothyroidism include the following:
• Anaemia

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• Dilutional hyponatremia

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• Hyperlipidemia
• Reversible increases in creatinine

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• Elevations in transaminases and creatinine kinase
No universal screening recommendations exist for thyroid disease for adults. The American Thyroid
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Association recommends screening at age 35 years and every 5 years thereafter, with closer attention to
patients who are at high risk, such as the following:
• Pregnant women
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• Women older than 60 years
• Patients with type 1 diabetes or other autoimmune disease
• Patients with a history of neck irradiation
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Text B

Pediatric Dosage - Congenital or Acquired Hypothyroidism

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Start Levothyroxine sodium tablets at the full daily dose in most pediatric patients. Use a lower starting
dose in newborns (0-3 months) at risk for cardiac failure and in children at risk for hyperactivity. Monitor for
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clinical and laboratory response.

Levothyroxine Sodium Tablets Dosing Guidelines for Pediatric Hypothyroidism

AGE Daily Dose Per Kg Body Weight*

0-3 months 10-15 mcg/kg/day

3-6 months 8-10 mcg/kg/day

6-12 months 6-8 mcg/kg/day

1-5 years 5-6 mcg/kg/day

6-12 years 4-5 mcg/kg/day

Greater than 12 years but growth and puberty incomplete 2-3 mcg/kg/day

Growth and puberty complete 1.6 mcg/kg/day

©Cambridge Boxhill Language Assessment Pty Ltd 2020

 PPP Reading07

Text C
Important Safety Issues with Consideration to Related Drugs
Over-or Under-Replacement with Thyroid Hormone
Because of their narrow therapeutic index, over-or under-treatment with thyroid hormones such as
levothyroxine may have a number of adverse effects.
Cardiac Adverse Reactions
Overtreatment with thyroid hormone may cause increase in heart rate, cardiac wall thickness and cardiac
contractility, and may precipitate angina or arrhythmias, particularly in elderly patients and those with underlying
cardiovascular disease.
Worsening of Diabetic Control
Initiation of thyroid hormone therapy may worsen diabetic control and cause hyperglycemia in patients with
diabetes mellitus.
Decreased Bone Mineral Density Associated with Thyroid Hormone Over-Replacement
Over-replacement with thyroid hormones may cause increased bone resorption and decreased bone mineral
density, particularly in post-menopausal women.

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Myxedema Coma
Myxedema coma may result in unpredictable absorption of levothyroxine from the gastrointestinal tract.
Use of oral thyroid hormone drug products is not recommended in patients with myxedema coma. Health
care practitioners should use thyroid hormone products formulated for intravenous administration to treat

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myxedema coma.
Adverse Reactions in Children
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Pseudotumor cerebri and slipped capital femora epiphysis are associated with initiation of levothyroxine therapy
in children. Over-replacement in children may result in craniosynostosis in infants and premature closure of the
epiphyses in children with resultant compromised adult height.
Hypersensitivity Reactions
Patients treated with thyroid hormone products have experienced hypersensitivity reactions to inactive
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ingredients, including urticaria, pruritus, skin rash, flushing, angioedema, gastrointestinal symptoms, fever,
arthralgia, serum sickness and wheezing.
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Text D
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Nutritional advice for patients with hypothyroidism

People with hypothyroidism should base their diet around vegetables, fruit and lean meats. They are low
in calories and very filling, which may help prevent weight gain. It should be emphasised to patients that
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this is not a restrictive diet, and that there are plenty of food options available to them, including:
• eggs - whole eggs are best, as much of the iodine and selenium beneficial for patients is found in
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the yolk, while the whites are full of protein

• meat
• fish
• vegetables - all vegetables are fine to eat, though cruciferous vegetables (e.g. broccoli, kale,
spinach, cabbage) should be eaten cooked, in moderate amounts
• fruits - apart from peaches, pears and strawberries
• gluten-free grains and seeds - e.g. rice, buckwheat, uinoa, chia seeds and fla seed
• dairy - all dairy products including milk, cheese, yogurt, etc.
• beverages - preferably water and other beverages that are not caffeinated.

END OF PART A
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