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Graves disease — MCCQE Part 1 MCQ

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ModerateThyroid DisordersGraves diseaseMCCQE Part 1

33-year-old woman presents with weight loss, tremor and palpitations. She has diffuse goitre, lid lag and suppressed TSH with high free T4. Which of the following is the most appropriate next step?

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Correct answer: A — Start beta-blockade and confirm Graves disease with antibodies/uptake before definitive therapy

Start beta-blockade and confirm Graves disease with antibodies/uptake before definitive therapy is best because clinical hyperthyroidism with eye signs suggests Graves disease. Discharge with reassurance and routine follow-up only is suboptimal because it underestimates acute or progressive risk; Treat symptomatically and defer definitive assessment is suboptimal because symptom control alone does not address the likely underlying diagnosis; Arrange non-urgent outpatient imaging in several months is suboptimal because delayed imaging is unsafe when the presentation has red flags; Start long-term corticosteroids without confirming the diagnosis is suboptimal because empiric steroids can obscure infection, malignancy or other diagnoses. Beta-blockers treat adrenergic symptoms while the cause is clarified.

Reference: Canadian endocrine guidance