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 BOF 54

 

   

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BOF: 54

A 40-year-old male is admitted for further investigation. He gives a history of feeling lethargic and depressed.

One year prior to admission he had been severely ill with meningitis and feels that all his symptoms began after that illness.

He was not on any medication.

On examination he looked pale, he had thinning of the hair on the front of his head and thinning of his eyebrows.

There was paucity of axillary and pubic hair. His blood pressure was 120/70

The cardiovascular and respiratory systems were normal on examination, abdominal examination was normal and he did not have a goitre.

Neurological examination was normal apart from increase in the ankle jerk relaxation time.

Investigations

Hb 13.5 g/dL

WBC 8.6 x 109 /L

ESR 10 mm in 1st hour

Sodium 126 mmo /L

Potassium 3.7 mmol/L

Urea 3.5 mmol /L

T 4 40 nmol/L

You ask your house office what the diagnosis is and the house office replies that the patient has primary hypothyroidism

You tell the house officer that on the basis of one of the physical signs you feel that this is not correct.

Which of the following make you suspect that the diagnosis is not primary hypothyroidism?

a)      Slow ankle jerk relaxation time

b)      Frontal balding

c)      Thinning of eyebrows

d)      Loss of axillary and pubic hair

e)      Pallor

 

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