QuestionSBA
QuestionChoice
Anxiety is not an appropriate diagnosis in patients presenting with symptoms of thyrotoxicosis and painful goitre.
10000445
e
Anxiety
QuestionChoice
Hashimoto's thyroiditis is a common cause of hypothyroidism and is not the most likely causative factor here. Hashimoto's classically presents with symptoms of hypothyroidism (e.g. weight gain, low mood, fatigue etc) as well as a firm, non-tender goitre. This patient has presented with symptoms of thyrotoxicosis and a tender goitre, therefore the most likely diagnosis is De Quervain's thyroiditis.
10000443
c
Hashimoto's thyroiditis
QuestionChoice
Although Grave's disease is the most common cause of hypothyroidism, it is not the most likely cause here. It is very uncommon for Grave's disease to present with a tender goitre, typically goitre in Grave's disease is diffuse but painless. De Quervain's thyroiditis is the most common cause of painful goitre and is therefore the most likely diagnosis here.
10000442
b
Grave's disease
QuestionChoice
De Quervain's thyroiditis (also known as subacute thyroiditis) is a transient inflammation of the thyroid gland. De Quervain's thyroiditis is characterised by three phases: initial thyrotoxicosis (due to the release of thyroglobulin during gland destruction) which is followed by hypothyroidism and finally a return to normal thyroid function. The initial phase of thyrotoxicosis classically presents with a painful goitre and symptoms of elevated thyroid hormone.
10000441
a
De Quervain's thyroiditis
QuestionChoice
An important differential but not the most likely cause here. Toxic multinodular goitre occurs due to the development of individual thyroid nodules which develop the autonomous ability to secrete thyroid hormone. Toxic multinodular goitre classically presents with a more subtle, subclinical hyperthyroidism as well as the development of an irregular and nodular goitre. This patient has presented with more acute thyrotoxicosis and a painful goitre, therefore De Quervain's thyroiditis is a much more likely diagnosis.
10000444
d
Toxic multinodular goitre
QuestionComment
o.O
51091
User
subscriber
Lisan al Ghrelin
Concept
Chapter
2693
3765
Hypothyroidism
Topic
133
Endocrinology
12635
A 46-year-old female presents to General Practise with a 3-week history of anxiety, palpitations and restlessness. She has also noticed a painful neck swelling which is causing significant discomfort. On examination, you identify a tender, diffuse, firm neck goitre.

Which of the following is the most likely diagnosis?
a