Endocrinology Question 1 Instructor

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

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