The answer is C. Graves’ disease
The patient’s clinical presentation of weight loss, palpitations, heat intolerance, a diffusely enlarged thyroid gland, tachycardia, and fine tremors, along with laboratory findings of decreased TSH and elevated free T4, are consistent with hyperthyroidism. The most common cause of hyperthyroidism in a young woman with these features is Graves’ disease. Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins that activate the TSH receptor, leading to diffuse thyroid enlargement and overproduction of thyroid hormones.
Explanation for Incorrect Answers:
A. Hashimoto’s thyroiditis: Hashimoto’s thyroiditis is an autoimmune thyroid disorder, but it typically leads to hypothyroidism, not hyperthyroidism. Patients may have a transient hyperthyroid phase, but it is not usually accompanied by the diffuse goiter and other classic signs of Graves’ disease.
B. Subacute thyroiditis: Subacute thyroiditis can cause transient hyperthyroidism, but it is usually associated with a painful thyroid gland and a history of a recent upper respiratory tract infection, which is not described in this case.
D. Toxic multinodular goiter: While toxic multinodular goiter can cause hyperthyroidism, it is more common in older patients and typically presents with multiple nodules in the thyroid, rather than a diffuse enlargement.
E. Thyroid storm: Thyroid storm is a life-threatening exacerbation of hyperthyroidism and presents with severe symptoms such as fever, delirium, severe tachycardia, and vomiting. The patient’s presentation is not consistent with the extreme nature of thyroid storm.
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