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iatroX Rounds #30

Thursday, 23 July 2026·Endocrinologyeasy

The clues

  1. 1

    A 32-year-old woman presents with persistent palpitations, irritability, and unintended weight loss despite an increased appetite.

  2. 2

    She reports being very sensitive to heat and examination confirms the presence of a fine tremor in both hands.

  3. 3

    Clinical examination reveals a resting tachycardia and a smooth, symmetric, non-tender enlargement of the thyroid gland.

  4. 4

    Initial blood tests show a suppressed TSH of less than 0.01 mU/L and an elevated Free T4 of 52 pmol/L.

  5. 5

    There is an audible bruit on auscultation of the gland and physical inspection reveals bilateral proptosis.

  6. 6

    Laboratory investigations confirm the presence of circulating TSH receptor antibodies and there is firm, non-pitting thickening of the skin with a peau d'orange appearance over the shins.

the diagnosis
Graves' disease

<p>This condition is the most common cause of primary thyrotoxicosis in the UK [1]. It is an autoimmune disorder where IgG autoantibodies activate the TSH receptor, leading to excessive thyroid hormone synthesis [1]. This process also causes hypertrophy and hyperplasia of the thyroid follicles [1].</p>

  • <strong>Smooth diffuse goitre</strong> which is often associated with an audible bruit [1].
  • <strong>Specific eye signs</strong> such as proptosis, chemosis, and ophthalmoplegia [1].
  • <strong>Pretibial myxoedema</strong> which presents as firm, non-pitting thickening of the skin over the shins [1].
  • <strong>Biochemical profile</strong> featuring a suppressed TSH and elevated thyroid hormones [1].
pearl. <p><strong>Thyroid acropachy</strong>, involving digital clubbing and periosteal reactions, is a highly specific but rare manifestation of the disease [1].</p>

more Endocrinology rounds

A 38-year-old woman presents to her GP complaining of a 10 kg weight gain, mostly around her midsection, and irregular periods.#26A 32-year-old man presents with intermittent episodes of severe anxiety, heart racing, and a feeling of impending doom.#23A 62-year-old woman presents to her GP complaining of feeling increasingly tired, thirsty, and generally under the weather for several months.#13A 52-year-old man presents to his GP complaining of persistent lethargy and generalized joint pains that have worsened over the last two years.#12

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