A 37-year-old man presents to his primary care physician because he has had constipation for the last several weeks. He has also been feeling lethargic and complains that this winter has been particularly cold. He also complains that he has been gaining weight despite no change in his normal activities. He reveals that two months prior to presentation he had what felt like the flu for which he took Tylenol and did not seek medical attention. Several days after this he developed anterior neck pain. Which of the following findings would most likely be seen on biopsy of this patient's abnormality?
AFocal hyperplasia
BGerminal follicles
CScalloped clear areas
DFibrous tissue
EGranulomatous inflammation
A 43-year-old woman presents to the physician with the complaint of worsening fatigue over the past several months. She has found that she requires nearly double the amount of coffee consumption each day to stay awake at work and that despite maintaining a balanced, healthy diet, she has experienced significant weight gain. A blood test confirms the presence of anti-thyroid peroxidase antibodies. Which of the following additional findings would be most consistent with the underlying pathophysiology of her condition?
AGalactorrhea
BConstipation
CBrisk deep tendon reflexes
DDiarrhea
EHeat intolerance
A 25-year-old woman presents to her primary care clinic for a general checkup. She states she's been a bit more fatigued lately during finals season but is otherwise well. Her mother and sister have hypothyroidism. She denies weight gain, cold intolerance, constipation, heavy or irregular menses, or changes in the quality of her hair, skin, or nails. Physical exam is unremarkable. Laboratory studies are ordered as seen below. Hemoglobin: 14 g/dL Hematocrit: 40% Leukocyte count: 5,500/mm^3 with normal differential Platelet count: 188,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 0.8 mg/dL Ca2+: 10.2 mg/dL Antithyroid peroxidase Ab: Positive AST: 12 U/L ALT: 10 U/L Which of the following laboratory values is most likely in this patient?
AElevated TSH and low T4
BElevated TSH and elevated T4
CNormal TSH and low T4
DNormal TSH and normal T4
ELow TSH and elevated T4
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