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Graves' disease — SCE Endocrinology MCQ

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EasyThyroidGraves' diseaseSCE Endocrinology

A 48-year-old woman reports weight loss, heat intolerance and palpitations. She has a fine tremor and a smooth goitre with a bruit. TSH is <0.01 mU/L, free T4 is 46 pmol/L and TSH receptor antibodies are positive. What is the most likely diagnosis?

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Correct answer: B — Graves' disease

Graves' disease is best because diffuse vascular goitre with overt thyrotoxicosis and positive TSH receptor antibodies strongly supports Graves' disease. The alternatives are less appropriate because toxic multinodular disease is nodular; thyroiditis has low uptake and often pain; factitious disease lacks goitre; TSHoma has non-suppressed TSH. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG145