DR.

MOHAMMED FALEH ALHARBI

(R2)
SUPERVISOR: DR. AZZA
ABDELMAJEED
◼
HOW DOES THE THYROID
GLAND FUNCTION?

◼
THYROID HORMONES SYNTHESIS
THYROID DISEASES
SIGN AND
SYMPTOMES
 Thyroid
Stimulating
Hormone (TSH
)
4-Thyroglobulin
 THYROID FUNCTION TESTS (TFTS)

•
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◼
EXERCISES
CASE
1
Asymptomatic 50-year-old woman undergoing a routine physical examination. Her TSH was 7 mU/mL.
TSH was repeated and found the same, with FT4 12 pmol/L.
What's your evaluation?
CASE
1
Asymptomatic 50-year-old woman undergoing a routine physical examination. Her TSH was 7 mU/mL.
TSH was repeated and found the same, with FT4 12 pmol/L.
What's your evaluation?

Subclinical hypothyroidism (low TSH + normal fT4)

CASE 2

A 43-year-old housewife complaining of progressive weight gain, fatigue, hair loss, constipation, cold
intolerance and dry skin. Thyroid gland is not palpable. Her TSH is 0.1 mU/L and fT4 is 5 pmol/L.

What's your evaluation?

CASE 2

A 43-year-old housewife complaining of progressive weight gain, fatigue, hair loss, constipation, cold
intolerance and dry skin. Thyroid gland is not palpable. Her TSH is 0.1 mU/L and fT4 is 5 pmol/L.

What's your evaluation?

Central hypothyroidism (low both TSH and FT4)

CASE
3 RAIU
A 28-year-old 3 months post-partum patient with signs and symptoms of
hyperthyroidism, including a smooth enlargement of the thyroid gland. Her TFT as
follows: TSH 0.01mU/mL, FT4 38pmol/L, 24hr RAIU <2 % .

What's your evaluation?

CASE
3 RAIU
A 28-year-old 3 months post-partum patient with signs and symptoms of
hyperthyroidism, including a smooth enlargement of the thyroid gland. Her TFT as
follows: TSH 0.01mU/mL, FT4 38pmol/L, 24hr RAIU <2 % .

What's your evaluation?

Transient hyperthyroidism due to postpartum thyroiditis (low TSH +high fT4 + low iodine
uptake)
34-year-old female comes to your office for evaluation of fatigue, hair loss, these symptoms have been
gradually worsening for the past few months. Her past medical history is unremarkable. She has gained 5
kg (11 lb) since her last office visit 18 months ago. Examination of the thyroid gland reveals tenderness but
no discrete nodules. Her TSH level is 7.5 U/mL (N 0.4–4.2), her T4 level is low, and her thyroid peroxidase
antibodies are elevated.
Which one of the following would be the most likely diagnosis ?

A- Euthyroid sick syndrome

B- Gravis disease
C- Hashimoto thyroiditis
D- Subacute thyroiditis
34-year-old female comes to your office for evaluation of fatigue, hair loss, these symptoms have been
gradually worsening for the past few months. Her past medical history is unremarkable. She has gained 5
kg (11 lb) since her last office visit 18 months ago. Examination of the thyroid gland reveals tenderness but
no discrete nodules. Her TSH level is 7.5 U/mL (N 0.4–4.2), her T4 level is low, and her thyroid peroxidase
antibodies are elevated.
Which one of the following would be the most likely diagnosis ?

A- Euthyroid sick syndrome

B- Gravis disease
C- Hashimoto thyroiditis
D- Subacute thyroiditis
❖ AAFP
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❖ BMJ best practice