QuestionSBA
QuestionChoice
This is an autoimmune disease causing thyrotoxicosis (hyperthyroidism). The blood tests would most likely show low TSH but high free T4, and the clinical features would likely include exophthalmos, pretibial myxoedema, weight loss, heat intolerance and palpitations.
10004638
c
Graves' disease
QuestionChoice
Babies are screened for congenital hypothyroidism at 5-7 days old using a heel-prick test. This is then treated in the first 4 weeks of life, and if untreated leads to irreversible cognitive impairment, short stature and hypotonia. As this woman is 44 years old and does not display any of these features, we can exclude this as a possibility.
10004637
b
Congenital hypothyroidism
QuestionChoice
This is an autoimmune disorder of the thyroid gland associated with the typical features of hypothyroidism, including dry skin, coarse hair, lethargy, cold intolerance and weight gain. This is ten times more common in women and is associated with other autoimmune conditions (e.g. coeliac disease in this case). Hashimoto’s thyroiditis does not commonly cause goitre, and thyroid function tests show a high TSH and low free T4.
10004636
a
Hashimoto's thyroiditis
QuestionChoice
Subacute thyroiditis is associated with a painful goitre. As no goitre is noted in this case, we can exclude this as the most likely diagnosis.
10004640
e
Subacute (de Quervain's) thyroiditis
QuestionChoice
This is a disease where fibrous tissue replaces the normal thyroid parenchyma, causing a painless goitre. As no goitre is noted in this case, we can exclude this as the most likely diagnosis.
10004639
d
Riedel thyroiditis
Concept
Chapter
2693
3959
Hyperthyroidism
Topic
133
Endocrinology
13474
A 44-year-old woman presents to her GP with concerns regarding very dry skin and scalp. She also notes that she has been feeling fatigued, and lethargic and is ‘cold all the time’. No goitre is noted upon examination. She has a past medical history of coeliac disease. Blood tests show a high TSH and low free T4.

What is the most likely diagnosis?
a