path/endo14 - milestones

[ArchivalUser]

An 35-year-old woman has had insomnia for the past 4 months. She has also had episodes of diarrhea with up to 4 loose stools per day. On physical examination, she exhibits bilateral proptosis. Her outstretched hands demonstrate a fine tremor. On palpation of her neck, the thyroid gland does not appear to be enlarged and no masses are palpable. Laboratory studies show a serum TSH of 8.8 microU/mL in association with a serum free thyroxine of 5.1 ng/dL. Which of the following is the most likely diagnosis?
A Graves disease
B Pituitary adenoma
C Chronic thyroiditis
D Prior thyroidectomy
E Nodular goiter

[ArchivalUser]

I guess it is BBB

[ArchivalUser]

A.

[ArchivalUser]

it is B

[ArchivalUser]

A Graves disease

[ArchivalUser]

sorry ..its A

[ArchivalUser]

hhcc please explain the reason for Increased TSH.......i thought it is decreased secondary to negative feedback.....

Thanx

[ArchivalUser]

A Graves disease

[ArchivalUser]

B) CORRECT. This combination of tests suggests that there is TSH coming from the pituitary, but there is no feedback inhibition. This suggests a pituitary adenoma is present. Such a TSH secreting pituitary adenoma is quite uncommon

[ArchivalUser]

I agree with B. If A then TSH should be low