Gynaecological endocrinology: hypothyroidism with hyperprolactinaemia: practice question

A OBG 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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OBG · Gynaecological endocrinology: hypothyroidism with hyperprolactinaemia

Sample item

A 28-year-old has amenorrhoea, galactorrhoea, fatigue and weight gain. TSH is markedly raised with low free T4, prolactin is moderately raised, and MRI shows symmetrical pituitary enlargement. What is the appropriate treatment?

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

The answer and the reasoning

B. Levothyroxine replacement

In primary hypothyroidism, raised TRH stimulates prolactin release and thyrotroph hyperplasia enlarges the pituitary. Thyroid replacement reverses the hyperplasia, normalises prolactin and restores menstruation, so surgery is not needed.

Option by option

  • A. Pituitary radiotherapy

    Radiotherapy risks hypopituitarism and has no role in reversible hyperplasia.

  • B. Levothyroxine replacement (correct)

    Correct. Replacing thyroxine removes the TRH drive and reverses the pituitary enlargement.

  • C. Trans-sphenoidal surgery

    Surgery would be unnecessary because the enlargement is hyperplasia and not a tumour.

  • D. Cabergoline

    Cabergoline treats the prolactin without correcting the underlying thyroid failure.

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.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is B, Levothyroxine replacement. In primary hypothyroidism, raised TRH stimulates prolactin release and thyrotroph hyperplasia enlarges the pituitary.

Why is "Pituitary radiotherapy" not the answer?

Radiotherapy risks hypopituitarism and has no role in reversible hyperplasia.

Why is "Trans-sphenoidal surgery" not the answer?

Surgery would be unnecessary because the enlargement is hyperplasia and not a tumour.

Why is "Cabergoline" not the answer?

Cabergoline treats the prolactin without correcting the underlying thyroid failure.

What concept does this question test?

It tests Gynaecological endocrinology: hypothyroidism with hyperprolactinaemia in OBG. Thyroid replacement reverses the hyperplasia, normalises prolactin and restores menstruation, so surgery is not needed.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Gynaecological endocrinology: hypothyroidism with hyperprolactinaemia?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG 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.