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Hypothyroidism — RACP Adult Medicine MCQ

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EasyEndocrinologyHypothyroidismRACP Adult Medicine

A 50-year-old man presents with fatigue, weight gain, constipation, cold intolerance, dry skin, and depression for 4 months. He has periorbital oedema. TSH is 35 mU/L, free T4 is 6 pmol/L (low). Anti-TPO antibodies are strongly positive. What is the most likely diagnosis?

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Correct answer: B — Hypothyroidism

Fatigue with weight gain, constipation, cold intolerance, dry skin, periorbital oedema, elevated TSH, low free T4, and positive anti-TPO is primary hypothyroidism (Hashimoto thyroiditis). Treatment: levothyroxine replacement (start 50-100 μg daily, lower starting dose in elderly/cardiac patients). Target TSH within reference range. Recheck TSH 6-8 weeks after dose changes.

Reference: eTG Endocrine – 2024 – Hypothyroidism; ESA 2024