Question:
A patient presents with a high TSH and a low T4. What is the probable diagnosis?
A patient presents with a high TSH and a low T4. What is the probable diagnosis?
Show Hint
High TSH with low T4 equals primary hypothyroidism, most often Hashimoto thyroiditis.
Updated On: Jun 24, 2026
- Grave's disease
- Hashimoto's disease
- Pituitary failure
- Hypothalamic failure
Show Solution
Verified By Collegedunia
The Correct Option is B
Solution and Explanation
Step 1: Interpret the thyroid function pattern. A high TSH with a low T4 indicates primary hypothyroidism. The thyroid gland is failing to produce thyroid hormone, and the pituitary responds by secreting more TSH to try to drive it, raising TSH.
Step 2: Localize the lesion. Because TSH is appropriately elevated, the pituitary is working normally; the defect is in the thyroid gland itself. This rules out pituitary and hypothalamic failure, where a low T4 would be accompanied by a low or inappropriately normal TSH.
Step 3: Identify the commonest cause. The most common cause of primary hypothyroidism in iodine sufficient areas is Hashimoto's (autoimmune chronic lymphocytic) thyroiditis.
Step 4: Exclude Graves disease. Graves disease causes hyperthyroidism with a low TSH and high T4, the opposite pattern.
Conclusion: The correct answer is option B, Hashimoto's disease.
Step 2: Localize the lesion. Because TSH is appropriately elevated, the pituitary is working normally; the defect is in the thyroid gland itself. This rules out pituitary and hypothalamic failure, where a low T4 would be accompanied by a low or inappropriately normal TSH.
Step 3: Identify the commonest cause. The most common cause of primary hypothyroidism in iodine sufficient areas is Hashimoto's (autoimmune chronic lymphocytic) thyroiditis.
Step 4: Exclude Graves disease. Graves disease causes hyperthyroidism with a low TSH and high T4, the opposite pattern.
Conclusion: The correct answer is option B, Hashimoto's disease.
Was this answer helpful?
0
0
Top NEET PG Medicine Questions
- Identify the condition associated with the murmur in the image below
- A young man came to the medical OPD with complaints of early morning backache and stiffness, which improves on exercise, and persistent red eyes. On examination, lung expansion was less than 3 cm. X-ray is shown in the image given below.
What is the most probable diagnosis? - A patient with hyperkalemia and elevated urea levels underwent dialysis. Towards the end of the session, she became drowsy and had a sudden seizure episode. On examination, thepatient was hypotensive. What is the treatment for this condition?
- A female patient presents to the emergency department with severe restlessness, palpitations, and tremors. She is a known case of bronchial asthma. On examination, the neck looksswollen. Blood pressure is elevated, and tachycardia is noted. ECG shows atrial fibrillation.Which of the following drugs is used for immediate management in this patient?
- A 30-year-old male is found to be positive for HBsAg and HBeAg and is diagnosed with chronic hepatitis B. The patient’s viral load was 2x 100000 and SGPT is found to be doubled. What is the appropriate management in this patient? SGPT-Serum glutamate pyruvate transaminase
View More Questions
Top NEET PG Hyperthyroidism Questions
- A patient has fatigue but is not gaining weight, and the body feels warm. Investigations are most likely to show:
- A 15 day old baby came with a history of seizures. Blood tests revealed Ca 5 mg/dl, PO4 9 mg/dl, PTH 30 pg/ml (normal 10 to 60). What is the most probable diagnosis?
- All of the following statements about pseudohypoparathyroidism are true, except:
Top NEET PG Questions
- A patient hailing from Delhi presents with fever, arthralgia, and extensive petechial rash for 3 days. Lab investigations revealed a hemoglobin of 9 g/ dL, a white blood cell count of 9000 cells/mm3, a platelet count of 20000 cells/mm3, and a prolonged bleeding time. The clotting time was normal. What is the most likely diagnosis?
- Which of the following statements is true about Trichomonas vaginalis?
- A lady from West Rajasthan presented with an ulcer surrounded by erythema on the right leg. Microscopy of the biopsy from the edge of the ulcer showed organisms with dark staining nuclei and kinetoplast. What is the most likely causative agent?
- A child presents with a fever and a rash. Urine examination showed cells with owl's eye appearance. What is the most likely diagnosis?
- Infection with Clonorchis sinensis is associated with an increased risk of__?
View More Questions