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A 31-year-old female complains of a 2-month history of a 15-lb unintentional weight loss,
anxiety, and "feeling jittery." The neck examination is unremarkable. Physical examination
shows tachycardia and increased deep tendon reflexes. Thyroid-stimulating hormone (TSH) is
below 0.01. Total T4 is elevated. Whole-body radionuclide iodine scan shows only low uptake in
the region of the thyroid. Serum thyroglobulin levels are within the normal range. What is the
most likely diagnosis?
A. Graves' disease
B. Struma ovarii
C. Subacute thyroiditis
D. Lymphocytic thyroiditis
E. Thyrotoxicosis factitia
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agreed,, D= painless is the ans
c= painful on exam
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It's E, Exogenous thyroid intake
Hyperthyroid- 1. Graves, 2. Thyroiditis 3. Exogenous
Graves- radio iodine uptake increased- ruled out here
dequervains - Painful- so ruled out here
subacute lypmhocytic- painless neck mass- here no neck mass at all!!!!! but thyroglobulin elevated- ruled out
This leaves us with exogenous Hormone- Facticia and struma ovarii, there are no indications towards struma here.Usually struma ovarii presents with syptoms of pelvic mass rather than thyroid symptoms
So the answer isssssssssss- Facticious hyperthyroidism
Thyroid is always fascinating.
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Pranav; I partialy agree with you but what is confusing is RAIU in facticiuos hyper. should be normal isn't it?
please clarify/
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question stem gives only low iodine uptake, it means - not high uptake- this could be normal uptake
What else it could be?? any other thoughts migrain1400???
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The answer is E.
Thyrotoxicosis factitia is characterized by exogenous of thyroid hormone. Radionuclide scans
show low uptake. Unlike the situation in cases of thyroiditis, serum thyroglobulin levels are low
or normal. Stuma ovarii and ectopic thyroid tissue are identified by evidence of uptake on
whole-body radionuclide scans. Graves' disease is characterized by diffuse thyroid enlargement
and increased uptake on uptake scanning.
