QuestionSBA
QuestionChoice
This is not the correct answer. Toxic multinodular goitre is when there are multiple thyroid nodules producing thyroid hormones which, as the name suggests, lead to goitre. This patient does not have a nodular goitre.
10027313
c
Toxic multinodular goitre
QuestionChoice
This is not the correct answer. De-Quervain's (subacute) thyroiditis is the painful inflammation of the thyroid thought to be triggered by a viral infection. It generally occurs in women aged 20 to 50 years old, but it also presents with features this patient did not have such as a high temperature and pain in the neck and/or jaw and/or ear.
10027314
d
De-Quervain's thyroiditis
QuestionChoice
This is not the correct answer. Features of hyperthyroidism such as restlessness, mood changes such as depression and anxiety and so forth can overlap with features of anxiety disorder, as such, it is an important diagnosis to consider. However, it should be considered as a separate diagnosis, especially in a patient who presents with other hyperthyroidism associated features.
10027315
e
Anxiety disorder
QuestionChoice
This is the correct answer. Raised free T4 and low TSH, along with the clinical features, imply hyperthyroidism. Hyperthyroidism mostly affects women and the elderly, and Grave's disease is the predominant cause. Grave's disease is an autoimmune condition involving thyroid receptor antibodies (Anti-TSH) which bind to TSH receptors and result in increased thyroid hormone synthesis and follicular enlargement (may manifest as goitre). Other manifestations include Grave's ophthalmoplegia, thyroid acropachy, and pretibial myxoedema, where the first two are present in this patient in the form of proptosis and finger clubbing respectively.
10027311
a
Grave's disease
QuestionChoice
This is not the correct answer. Hashimoto's thyroiditis is an autoimmune cause of hypothyroidism involving autoantibodies to thyroid peroxidase (Anti-TPO) and thyroglobulin (Anti-thyroglobulin) antibodies. In rare cases, initial destruction of the thyroid gland can release the thyroid hormones and cause temporary transient hyperthyroidism, known as hashitoxicosis, which is almost always followed by hypothyroidism. In most circumstances, thyroid function tests would show a low T4 and raised TSH, unlike the raised free T4 and low TSH in this patient.
10027312
b
Hashimoto's thyroiditis
Concept
Chapter
2693
3959
Hyperthyroidism
Topic
133
Endocrinology
17860
A 48-year-old woman complains of feeling hot all the time alongside diarrhoea, anxiety and restlessness. On examination, her positive findings include finger clubbing, mild proptosis and a heart rate of 98 beats per minute. Her TFT results show Free T4 of 35pmol/L (9 - 25 pmol/L) and TSH 0.1mu/L (0.3 - 4.2 mU/L).

What is her most likely diagnosis?
a