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Hashimoto Thyroiditis — RACP Adult Medicine MCQ

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EasyEndocrinologyHashimoto ThyroiditisRACP Adult Medicine

A 45-year-old woman presents with weight gain, fatigue, constipation, and cold intolerance. Examination shows dry skin, periorbital oedema, and delayed relaxation of ankle reflexes. TSH is 45 mU/L (0.4–4.0) and free T4 is 5 pmol/L (10–25). Anti-TPO antibodies are strongly positive. What is the most likely diagnosis?

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Correct answer: B — Hashimoto thyroiditis

Elevated TSH with low free T4 and positive anti-TPO antibodies in a patient with clinical hypothyroidism is diagnostic of Hashimoto thyroiditis (chronic autoimmune thyroiditis). It is the commonest cause of hypothyroidism in iodine-sufficient countries. Treatment is levothyroxine replacement titrated to normalise TSH.

Reference: ESA – 2024 – Thyroid Guidelines; eTG Endocrine 2024