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Acquired hypothyroidism — MRCPCH FOP MCQ

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ModerateEndocrinology and growthAcquired hypothyroidismMRCPCH FOP

A 13-year-old girl has fatigue, constipation, cold intolerance and slowed growth. Blood tests show TSH 28 mU/L with low free T4 and positive thyroid peroxidase antibodies. What is the most likely cause?

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Correct answer: B — Autoimmune thyroiditis

Raised TSH, low free T4 and positive thyroid peroxidase antibodies indicate primary hypothyroidism due to autoimmune thyroiditis. Graves' disease causes hyperthyroidism with suppressed TSH. Central hypothyroidism would have low or inappropriately normal TSH. The pearl is that growth deceleration may be a more sensitive clue than fatigue in children.

Reference: NICE CKS Hypothyroidism; BNFc levothyroxine