QuestionSBA
QuestionChoice
Incorrect - This patient demonstrates signs and symptoms of hyperthyroidism. The presence of exophthalmos specifically points towards Grave's disease. By contrast, reduced T4 levels are seen in cases of hypothyroidism such as Hashimoto's thyroiditis.
10008283
d
Reduced T4, Raised TSH
QuestionChoice
Incorrect - This patient demonstrates signs and symptoms of hyperthyroidism. The presence of exophthalmos specifically points toward Grave's disease. A normal T4 and reduced TSH may be seen in a patient with subclinical hyperthyroidism.
10008284
e
Normal T4, Reduced TSH
QuestionChoice
Incorrect - This patient demonstrates signs and symptoms of hyperthyroidism. The presence of exophthalmos specifically points toward Grave's disease. By contrast, reduced T4 levels are seen in cases of hypothyroidism. Both reduced T4 and reduced TSH is indicative of a central/secondary cause of hypothyroidism such as a pituitary malfunction.
10008282
c
Reduced T4, Reduced TSH
QuestionChoice
Incorrect - This patient demonstrates signs and symptoms of hyperthyroidism. The presence of exophthalmos specifically points toward Grave's disease. In Grave's disease the auto-antibody TSI (thyroid stimulating immunoglobulin) is produced. This mimics the action of TSH, stimulating the TSH receptor, and therefore increasing T4 levels. TSH levels fall as part of a negative feedback cycle. Failure of TSH to fall in response to raised T4 indicates a central cause, such as a problem with the pituitary gland.
10008281
b
Raised T4, Raised TSH
QuestionChoice
Correct - This patient demonstrates signs and symptoms of hyperthyroidism. The presence of exophthalmos specifically points towards Grave's disease. This is a hypersensitivity reaction involving autoimmune activation of the TSH receptor. In Grave's disease the auto-antibody TSI (thyroid stimulating immunoglobulin) is produced. This mimics the action of TSH, stimulating the TSH receptor, and therefore increasing T4 levels. TSH levels fall as part of a negative feedback cycle.
10008280
a
Raised T4, Reduced TSH
Concept
Chapter
2693
4659
Patterns of Thyroid Disease
Topic
133
Endocrinology
14203
A 35-year-old woman presents to her GP with unexplained weight loss over the past few months. She states she has recently missed several periods and has noticed her heart beating faster.

On examination, she appears agitated and sweaty with noticeable bilateral exophthalmos. Her thyroid gland appears to be enlarged but is smooth and symmetrical to palpation. There is also evidence of pretibial myxoedema. The doctor orders a thyroid function blood test.

Which of the following findings is most likely?
a