Chapter 1 Overview

Engage your medical problem-solving abilities with this straightforward clinical scenario I devised.

A 58-year-old woman, who had been in good health, visits the outpatient clinic, expressing a primary concern of ongoing fatigue. She mentions that her tiredness has intensified over several months and she has unexpectedly gained 10 pounds. Despite not changing her eating habits or reducing her physical activity, she feels excessively cold, even when others around her seem comfortable. Upon examination, her skin appears dry, and a noticeable mass is felt on the anterior-medial aspect of her neck.

What could be the most likely diagnosis and associated lab results?

Answer Choices A. Hypothyroidism — Both TSH and free T4 are low. B. Hypothyroidism — TSH is low, free T4 is high. C. Hyperthyroidism — Both TSH and free T4 are low. D. Hyperthyroidism — TSH is low, free T4 is high. E. Hypothyroidism — TSH is high, free T4 is low.

Correct Diagnosis with Explanation: The most accurate diagnosis is E.

This patient likely has hypothyroidism. Symptoms such as fatigue, sensitivity to cold, weight gain, dry skin, and the presence of a goiter are all indicative of this condition. High TSH levels combined with low free T4 levels align with hypothyroidism.

1. Incorrect, as TSH levels would be elevated in hypothyroidism.
2. Incorrect, since TSH would be elevated while free T4 would be depressed.
3. Incorrect, because hyperthyroidism does not match the symptoms this patient exhibits. In hyperthyroidism, TSH would be low and free T4 high.
4. Incorrect, as hyperthyroidism is inconsistent with the patient’s signs and symptoms.
5. Correct. Refer to the rationale above.

For an in-depth exploration of this topic, watch this YouTube video:

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