A 24 year-old woman, Maria Aquino, presents with two-month history of weight loss, anxiety, hyperdefecation, scant menses, palpitations and hear intolerance. On exam, she appears anxious.
Aquino has: HR 126, BP 140/68, a fine tremor, very brisk reflexes, mildly enlarged thyroid (30 g), sTSH <0.01, free T4 46 (N 7.5-16), free T3 12 (N 3.5-6)
What are the two most likely diagnoses in your differential? How do you differentiate them?
- Graves’ disease
- Subacute thyroiditis
- More on history:
- other autoimmune diseases
- positive family history of Graves’
- orbitopathy or pretibial myxedema
- history of preceding URTI or pregnancy
- painful/tender thyroid
- RAI uptake (if not pregnant, not on thiouracils, no iodine ingestion recently)
- elevated with Graves’ disease
- multinodular goiter
- toxic adenoma
- molar pregnancy/choriocarcinoma
- low with subacute thyroiditis, exogenous thyroid (medication or thyroid gland ingestion), struma ovarii
- TSI (thyroid stimulating immunoglobulin)
- takes a while to get back
- ESR is elevated in subacute thyroiditis
