QuestionSBA
QuestionChoice
Thyroid cancer is unlikely in this patient as, although the patient has experienced weight loss, given the other symptoms, this is more likely to be caused by the patient's hyperthyroid state. Individuals with thyroid cancer typically present in advanced stages of the disease, with hoarseness of the voice, sore throat, difficulty swallowing, and goitre being common symptoms. Other symptoms of hyperthyroidism are rare in thyroid cancer.
10006874
d
Thyroid cancer
QuestionChoice
Hashimoto's disease is an autoimmune disorder which causes hypothyroidism, not hyperthyroidism. Examples of symptoms would include fatigue, weight gain, cold intolerance and constipation. It may cause a goitre.
10006875
e
Hashimotos disease
QuestionChoice
Graves disease is the most common cause of thyrotoxicosis, and usually presents with signs of hyperthyroidism (such as anxiety, palpitations, heat intolerance, sweating, and weight loss). Graves disease is unlikely in this patient due to the rough goitre (smooth in Graves' disease), and patchy nuclear scintigraphy uptake (would be diffuse in Graves').
10006873
c
Graves disease
QuestionChoice
De Quervain's thyroiditis, also known as subacute thyroiditis, commonly presents with a painful goitre which is absent in this patient. It follows a course of hyperthyroidism followed by euthyroidism, hypothyroidism, and then returns to euthyroidism. They are often associated with recent viral upper respiratory tract infections.
10006872
b
De Quervain's thyroiditis
QuestionChoice
Toxic multinodular goitre presents with a rough goitre, and nuclear scintigraphy typically shows patchy uptake. This is a cause of hyperthyroidism in which excess thyroid hormone is secreted from multiple autonomous thyroid nodules. These secrete thyroid hormones independently of TSH and are typically benign.
10006871
a
Toxic multinodular goitre
Concept
Chapter
2693
3959
Hyperthyroidism
Topic
133
Endocrinology
13921
A 63-year-old female presents complaining of anxiety and significant weight loss. She has been passing looser stools than normal over the preceding few weeks and is wearing just a t-shirt and shorts, despite it being a cold winter's day. On examination, she has a rough goitre which is not painful, and a slight tremor bilaterally.
Blood tests show a TSH of 0.05, and a free T4 of 39. A nuclear scintigraphy scan is organised which shows patchy uptake.
Which of the following is the most likely diagnosis in this patient?
a