A patient presents with B/L proptosis, heat intolerance and palpitations; most unlikely diagnosis here would be
Answer is D (Reidel's thyroiditis) : Reidel's thyroiditis is usually a consistently hypothyroid condition. The patient in the given question is presenting with symptoms of Hypehyroidism. The condition, most unlikely to produce the picture is the one where hypehyroidism is not a feature, not even transient. Reidel's thyroiditis is one such consistently hypothyroid condition. Thyrotoxicosis is usual with thyroid adenoma and diffuse thyroid goitre and Hashimoto's thyroiditis can present with transient hypehyroidism. Hashimoto's Thyroiditis (Auto immune): In this variant, mild hypehyroidism may be present initially, although hypothyroidism is inevitable. Hypothyroidism may develop rapidly or extremely slowly. The initial phase of hypehyroidism may account for the symptoms in the given patient. Thyroid adenoma, diffuse toxic goitre or Grave's disease, toxic nodular goitre, toxic nodule: All are causes of thyrotoxicosis & explain the symptoms of thyrotoxicosis in the above patient. 733/L&B Riedle's thyroiditis is a very rare disease wherein , the thyroid tissue is replaced by cellular fibrous tissue. The goitre may be unilateral or bilateral & is very hard and fixed. This condition presents with features of hypothyroidism. Hypehyroidism is not manifested, not even transiently. The differential diagnosis is from an anaplastic carcinoma & can be made with ceainity only by biopsy. Diffuse thyroid goitre :Most commonly presents with a euthyroid status however patients may present with hypehyroidism.
Hoshimoto's thyroiditis
Thyroid adenoma
Diffuse thyroid goitre
Reidel's thyroiditis