A 30-year-old woman with a history of Grave’s disease presents to her physician for a routine evaluation. She was treated 2 years ago with radioactive iodine. Three months later, she was prescribed levothyroxine 0.125 mg. On her last evaluation, six months ago, her doctor lowered her dose to 0.088 mg due to decrease of TSH level.
Today, her lab tests show an increase in T4 and T3 and very low TSH and positive TSH receptor antibodies.
What is the most likely diagnosis?
A- Hashimoto’s disease
B- Radioactive induced thyrotoxicosis
C- Ectopic thyroid tissue
D- Incomplete ablation of thyroid gland
E- Cancer thyroid
Answer:
This is a typical presentation of incomplete ablation of thyroid gland. The patient went through radioactive ablation of his thyroid gland 2 years ago. In some cases, there is some thyroid tissue could be left after radiotherapy and starts to grow in size until becomes able to cause hyperthyroidism in addition to the use of levothyroxine treatment.
The correct answer is D
Hashimoto’s disease is characterized by low T3 and high TSH. It is most likely incomplete ablation of thyroid gland and reactivation of hyperthyroidism.
Why not hashimoto ds??
D