A 44-year-old woman presents to clinic with a 6-month history of progressive fatigue, difficulty concentrating, and cold intolerance. She reports a 3-kg weight gain despite no change in appetite. On examination, pulse is 52 bpm, blood pressure is 118/76 mmHg, and temperature is 36.2°C. Thyroid examination reveals a small, firm, non-tender gland without nodules. Laboratory studies show: TSH: 0.8 mIU/L (0.5-5.0) Free T4: 0.6 ng/dL (0.8-1.8) Thyroid peroxidase (TPO) antibody: positive (>35 IU/mL) Thyroglobulin (Tg) antibody: positive (>40 IU/mL) TSH-receptor antibody (TRAb): negative Which of the following is the most likely diagnosis?
- A)Hashimoto's thyroiditis with early hypothyroidism and autoimmune destructionGABARITO
- B)Graves' disease with TSH suppression from thyroid hormone excess
- C)Secondary hypothyroidism from pituitary insufficiency
- D)Euthyroid sick syndrome from chronic illness
- E)Thyroid hormone resistance syndrome with target tissue insensitivity
Explicação
This patient has Hashimoto's thyroiditis with early hypothyroidism. The positive TPO and thyroglobulin antibodies in the setting of clinical hypothyroid symptoms (fatigue, cold intolerance, weight gain, bradycardia), low-normal free T4, and normal-range TSH in... Ver explicação completa e trilha adaptativa →