Signs and Symptoms of Thyroid Disease Author: Bernard M. Karnath, MD
	Choose the single best answer for each question. 1. A 35-year-old woman presents with a 2-month history of nervousness, palpitations, heat intolerance, frequent stools, and a 15-lb weight loss. Laboratory examination reveals a serum thyroid-stimulating hormone (TSH) level below 0.01 µU/mL (normal, 0.5-5.0 µU/mL] and a free thyroxine (FT4) level of 2.9 ng/dL (normal, 0.8-1.8 ng/dL). A radio- active iodine uptake (RAIU) scan shows diffuse uptake. What is the most likely diagnosis? Graves’ disease Toxic nodular goiter Hashimoto’s thyroiditis de Quervain’s thyroiditis Factitious thyrotoxicosis Click here to compare your answer. 2. A 39-year-old man presents with a 4-week history of weight loss, palpitations, and soreness in his neck. He reports that he had an upper respiratory tract infection about 1 month ago. Family history for thyroid disease is negative. On physical examination, his neck is extremely tender in the region of the thyroid gland. Laboratory examination reveals a serum TSH level below 0.01 µU/mL and a serum FT4 level of 3.1 ng/dL. What is the most likely diagnosis? Graves’ disease Toxic nodular goiter Hashimoto’s thyroiditis de Quervain’s thyroiditis Factitious thyrotoxicosis Click here to compare your answer.		3. A 32-year-old woman is referred to you by her psychiatrist because of an enlarging goiter. The patient has a history of bipolar disease for the past 5 years and has been treated with lithium. Her medical history is otherwise unremarkable. Over the past year, she has gained 15 lb and constipation has been a problem. On physical examination, she is an obese woman with an obvious goiter. Examination of the neck shows a diffusely enlarged thyroid gland. Her deep tendon reflexes are delayed in the relaxation phase. Laboratory examination reveals a serum T4 level of 4.0 µg/dL and a serum TSH level of 45.3 µU/mL. What is the most likely diagnosis? Graves’ disease Toxic nodular goiter Hashimoto’s thyroiditis Lithium-induced hypothyroidism Factitious thyrotoxicosis Click here to compare your answer. 4. A 65-year-old man presents with failure to thrive. He has lost 15 lb in the past month. He has a anorexia, lethargy, constipation, and cold intolerance. The thyroid gland is difficult to palpate and deep tendon reflexes have a delayed relaxation phase. Laboratory examination reveals a serum T4 level of 1.0 µg /dL, FT4 level of 0.1 ng/dL, and a TSH level of 0.4 µU/mL. What is the most likely diagnosis? Graves’ disease Toxic nodular goiter Hashimoto’s thyroiditis de Quervain’s thyroiditis Pituitary tumor Click here to compare your answer.
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