Thyroid Disorders

Case 1: A Rural Middle-Aged Woman

“Doctor saab, for the past few months, I’ve been so tired. Even after a full night's sleep, I wake up feeling drained. I’ve gained 4 kilos without eating much, and my skin feels so dry and cracked. I also feel colder than others, and my periods have become unusually heavy and longer.”

• TSH: 9.2 mIU/L ↑

• FT4: 0.4 ng/dL ↓

• FT3: 190 pg/dL ↓

• Primary Hypothyroidism

• Primary Hyperthyroidism

• Subclinical Hypothyroidism

• Subclinical Hyperthyrodism

Case 2: College Student with Anxiety and Weight Loss

“Sir, I’ve lost nearly 5 kilos in one month despite eating more than usual. My hands shake when I try to write, I sweat constantly, and I can feel my heart pounding even when resting. I feel very anxious and easily irritated. My neck feels a bit swollen too.”

• TSH: <0.01 mIU/L ↓↓

• FT4: 2.9 ng/dL ↑

• FT3: 470 pg/dL ↑

• T3 Toxicosis

• Euthyroid Sick Syndrome

• Grave's Disease (Autoimmune Hyperthyroidism)

• T4 Ingestion Disorder

Case 3: Office-Goer on Routine Checkup

“I feel mostly fine, doctor, but sometimes I get this uneasy heartbeat and mild tremors. It doesn’t disturb me much, but my company health report showed thyroid abnormality.”

• TSH: 0.25 mIU/L ↓

• FT4: 1.2 ng/dL (Normal)

• FT3: 290 pg/dL (Normal)

• Hashimoto's Thyroiditis

• Subclinical Hypothyroidism

• Subclinical Hyperthyroidism

• Euthyroid Sick Syndrome

Case 4: Pregnant Woman – 1st Trimester

“I’m 6 weeks pregnant. I just wanted to check my thyroid because we’re planning this baby carefully.”

The doctor diagnosed him as Subclinical Hypothyroidism because in her TFT,

FT4 was normal, but (a)   was high.

Case 5: Teenage Boy with Growth Delay

“Doctor, I’m always sleepy in class. My weight keeps increasing, but my height hasn’t changed much in a year. I’m not very active, and my mother says my voice seems dull. I also have occasional constipation.”

• TSH: 12.5 mIU/L ↑

• FT4: 0.5 ng/dL ↓

• FT3: 180 pg/dL ↓

• TSH Producing Adenoma

• Subclinical Hyperthyroidism

• Subclinical Hypothyroidism

• Primary Hypothyroidism

Case 6: Elderly Man with Insomnia and Weight Loss

“I’m 70 and feel tired, but can't sleep at night. My heart beats very fast. I’ve lost 6 kilos without trying, and even in winter, I sweat a lot. My family says I seem restless and talk more than usual.”

• TSH: 0.01 mIU/L ↓

• FT4: 3.0 ng/dL ↑

• FT3: 440 pg/dL ↑

• Goiter

• Central Hypothyroidism

• Central Hyperthyroidism

• T3 Toxicosis

Case 7: ICU Patient with Infection

“I was admitted for severe pneumonia. I’ve had no thyroid complaints before. I haven’t eaten properly in a few days and feel very weak. They said my thyroid tests are abnormal, but I don’t understand how.”

• TSH: 0.4 mIU/L ↓

• FT4: 0.7 ng/dL ↓

• FT3: 130 pg/dL ↓

• Primary Hypothyroidism

• Subclinical Hypothyroidism

• Euthyroid Sick Syndrome

• Pituitary Adenoma

Case 8: Child with Constant Headache

“Doctor, I’ve been having frequent headaches, and my vision has become blurry, especially from the sides. I’ve also noticed weight loss and increased sweating. But the strange part is—my thyroid tests show high TSH and high hormones. How is that possible?”

• TSH: 7.5 mIU/L ↑

• FT4: 2.5 ng/dL ↑

• FT3: 460 pg/dL ↑

• T4 Ingestion Toxicosis

• T3 Toxicosis

• TSH-Secreting Pituitary Adenoma

• Primary Hyperthyroidism

Identify the disease

• Hashimoto's Thyroiditis

• Exophthalmic Goiter

• Pituitary Adenoma

• Secondary Hyperthyroidism

In case of pituitary adenoma, there will be a condition in which the TSH, FT4, and FT3 will be?

(a)