Thyrotoxic Weight Loss — RACP Adult Medicine MCQ

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EasyEndocrinologyThyrotoxic Weight LossRACP Adult Medicine

A 35-year-old woman presents with 8 kg weight loss despite increased appetite, heat intolerance, tremor, palpitations, and diarrhoea. She has a diffuse goitre with a bruit. HR 105 bpm regular. Eyes show mild proptosis. TSH is <0.01 mU/L, free T4 55 pmol/L. What is the most likely underlying cause?

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Correct answer: A — Hyperthyroidism

Weight loss with INCREASED appetite, heat intolerance, tremor, tachycardia, diarrhoea, diffuse goitre with bruit, and proptosis with suppressed TSH and markedly elevated fT4 is Graves disease (hyperthyroidism). Weight loss with increased appetite narrows the differential to hyperthyroidism, uncontrolled diabetes, malabsorption, and phaeochromocytoma. Thyroid function should be checked in all patients with unexplained weight loss.

Reference: eTG Endocrine – 2024 – Hyperthyroidism; ESA 2024