A 46-year-old woman presents with weight loss. On examination, you note that she has prominent eyes, ‘lumpy’ swelling over her shins and the neck lump seen in the image above.
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This patient has a history of weight loss in combination with prominent eyes, swelling over her shins and a goitre. The most likely underlying diagnosis is that of Grave’s disease, with the prominent eyes representing Grave’s ophthalmopathy.
Grave’s disease is an autoimmune disease caused by the abnormal production of a TSH receptor antibody that causes the excessive production of thyroid hormones.
Question image adapted from Wikipedia
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The lumpy rash on her shins is likely to be pretibial myxoedema.
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A low TSH and an elevated T3 or T4 would occur in hyperthyroidism of any cause, and this is not diagnostic of Grave’s disease.
The thyroid-stimulating immunoglobulin (TSI) assay is almost always positive in Grave’s disease and, when positive, is diagnostic for it.
Short and spot on.