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Graves disease — RACP Adult Medicine MCQ

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ModerateEndocrinology and diabetesGraves diseaseRACP Adult Medicine

A 35-year-old woman has weight loss, tremor and palpitations. Examination shows diffuse goitre, lid retraction and a bruit over the thyroid. TSH is suppressed and free T4 is elevated. What is the most likely diagnosis?

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Correct answer: E — Graves disease

Diffuse goitre with bruit and orbitopathy supports Graves disease as the cause of thyrotoxicosis. Thyroiditis is usually tender or post-viral with low uptake, toxic nodular disease is nodular and often older, and factitious ingestion lacks goitre. A TSH-secreting adenoma would not have suppressed TSH.

Reference: Therapeutic Guidelines (eTG) Endocrinology; AMH