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 Best of Five 235

 

   

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BOF: 235

A 22-year-old female is admitted with a history of loss of weight, diarrhoea and secondary amenorrhoea. Her mother is known to have hypothyroidism and is on thyroxin. On examination she is thin, there are no thyroid eye signs, her palms are warm and sweaty, there is a fine tremor of her hands and she has a resting tachycardia. Her thyroid gland is not palpable; there is no tenderness over her thyroid. Pembertonís sign cannot be elicited. There is evidence of proximal myopathy. Chest x-ray is unremarkable. Investigations show raised levels of T4 and T3 and TSH levels are undetectable.

In this patient which of the following features favours the diagnosis of thyrotoxicosis factitia?

a)      No ophthalmopathy

b)      No thyroid acropachy

c)      No thyroid tissue palpable

d)      Secondary amenorrhoea

e)      Proximal myopathy

 

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