Question

17 yo with neck swelling for 2-3 weeks, 5lb weight gain, and feeling more tired. Exam shows diffusely enlarged, smooth, and non-tender thyroid. What initial test would you order for this patient?

Answer 1

For a patient with an enlarged thyroid and symptoms of weight gain and fatigue, an initial blood test to check thyroid function, including TSH and free T4 levels, is recommended to diagnose potential thyroid disorders.

Step-by-step explanation:

The initial test that would be appropriate for a 17-year-old patient with a diffusely enlarged, smooth, non-tender thyroid and associated symptoms like weight gain and fatigue is a blood test to measure thyroid function, specifically thyroid-stimulating hormone (TSH) and potentially free thyroxine (T4). These tests will help determine if the patient has a thyroid disorder, such as hypothyroidism.

A TSH deficiency could cause weight gain and fatigue because TSH is responsible for stimulating the production and release of thyroid hormones from the thyroid gland. When TSH levels are low, the thyroid gland may not produce enough thyroid hormones, leading to a condition called hypothyroidism. In hypothyroidism, the body's metabolism slows down, resulting in weight gain and feelings of exhaustion. It is important to note that additional testing may be required to determine the specific cause of the TSH deficiency and to guide further management.