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Thyrotoxicosis — RACGP Fellowship MCQ

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ModerateChronic disease managementThyrotoxicosisRACGP Fellowship

A 32-year‑old man presents with palpitations, tremor and weight loss. Pulse is 112/min, there is a fine tremor and TSH is suppressed with elevated free T4. He has no eye signs and is clinically stable. What is the most appropriate initial management?

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Correct answer: E — Start a beta‑blocker for symptom control and arrange thyroid antibody testing with endocrinology‑guided definitive care

This patient has overt thyrotoxicosis with adrenergic symptoms (palpitations, tremor, tachycardia). Australian general practice guidelines recommend beta‑blockers for rapid symptomatic relief, and referral to endocrinology (with thyroid antibody testing) when thyroiditis is unlikely to guide definitive therapy (e.g. Graves’ disease and antithyroid drugs) ([racgp.org.au](https://www.racgp.org.au/afp/2012/august/evaluating-and-managing-patients-with-thyrotoxicosis/?utm_source=openai)). Option A is contraindicated—levothyroxine worsens thyrotoxicosis. Option B is unnecessary for a stable first presentation. Option D is irrelevant and potentially harmful. Option C is unsafe, as delaying treatment risks complications. Thus D is the sole correct answer.

Reference: Royal Australian College of General Practitioners. Evaluating and managing patients with thyrotoxicosis. Australian Family Physician. 2012. https://www.racgp.org.au/afp/2012/august/evaluating-and-managing-patients-with-thyrotoxicosis