The Daily PANCE and PANRE Question 33

Laboratory report: elevated serum free t4;  low serum TSH level. Which of the following is the MOST likely diagnosis?

  1. Primary hypothyroidism
  2. Secondary hypothyroidism
  3. T3 thyrotoxicosis
  4. Graves disease
  5. Chronic Hashimoto's thyroiditis

Answer: D

Graves disease

High T4 (hyperthyroid), with a low TSH, indicates that the pituitary is working normally, and the thyroid is hyperactive i.e. Grave's disease. Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.

Know Your Content Blueprint

Graves disease is covered in the NCCPA™ Content Blueprint Endocrinology (6%)

16-year-old with ADHD presents with chest pain and exophthalmos

Review Topic: Hyperthyroidism

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