Question at position 6 A patient presents with irritability and chronic sweat. He also has a lump-like mass in his neck near his larynx. Blood tests show he has low levels of TSH (thyroid-stimulating hormone). Which of these is the most likely diagnosis?HypothyroidismAn iodine-insufficient dietGraves' diseaseHyposecretion of TRH

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Question at position 6 A patient presents with irritability and chronic sweat. He also has a lump-like mass in his neck near his larynx. Blood tests show he has low levels of TSH (thyroid-stimulating hormone). Which of these is the most likely diagnosis?HypothyroidismAn iodine-insufficient dietGraves' diseaseHyposecretion of TRH

BlackTom AI · Accepted Answer

Rewriting the scenario helps frame what we’re evaluating: a patient with irritability and chronic sweating, plus a neck lump near the larynx, and blood tests showing low TSH. Now let's examine each option in turn.
Option 1: Hypothyroidism. If this were the correct diagnosis, we would typically expect elevated TSH due to lack of thyroid hormones prompting more TSH release (primary hypothyroidism) or suppressed TSH if there is pituitary/ hypothalamic failure, but the common pattern in hypothyroidism is higher TSH, not low. Moreover, hypothyroidism usually causes symptoms like fatigue, weight gain, and cold intolerance rather than irritability and excessive sweating. This makes the option unlikely given the low TSH finding.
Option 2: An iodine-insufficient diet. Iodine deficiency commonly leads to hypothyroidism because iodine is essential for thyroid hormone synthesis. The downstream effect is usually an increased TSH level as the pituitary tries to stimulate the thyroid. Therefore, a low TSH contradicts the typical pathophysiology of iodine deficiency, rendering this option unlikely in the presence of low TSH.
Option 3: Graves' disease. This is a classic autoimmune hyperthyroidism. It often presents with irritability, sweating, weight loss, tachycardia, and sometimes a palpable goiter or lump in the neck region due to thyroid enlargement. Importantly, hyperthyroidism suppresses TSH via negative feedback, leading to low TSH levels, which aligns with the laboratory finding described. The symptom cluster and the low TSH fit Graves' disease well.
Option 4: Hyposecretion of TRH. TRH deficiency would reduce TSH release from the pituitary, causing secondary hypothyroidism. In that scenario, you might see low TSH, but the clinical picture would more likely reflect hypothyroid symptoms (fatigue, cold intolerance, weight gain) rather than the hyperadrenergic symptoms like irritability and sweating seen here. Additionally, a neck lump is not a typical feature of TRH deficiency. This makes it a less plausible explanation for the presentation given.
In summary, among the options, Graves' disease best accounts for the combination of irritability and sweating with a neck lump and the laboratory finding of low TSH, whereas the other options either predict a different TSH pattern or a symptom profile that doesn’t match this case.

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