A 50-year-old patient presents with low T3, low T4 and elevated TSH, weight gain and depression. What is the most likely diagnosis?

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Multiple Choice

A 50-year-old patient presents with low T3, low T4 and elevated TSH, weight gain and depression. What is the most likely diagnosis?

Low T3 and T4 with an elevated TSH shows primary hypothyroidism: the thyroid gland isn’t producing enough hormone, so the pituitary raises TSH to try to stimulate it. The most common autoimmune cause in a middle-aged patient is Hashimoto thyroiditis, where immune-mediated destruction of thyroid tissue gradually reduces hormone synthesis. This fits with weight gain and depressive symptoms, and often with a non-tender, possibly enlarged thyroid and antibodies against thyroid peroxidase. Graves disease, in contrast, would elevate thyroid hormones with a suppressed TSH. Subacute thyroiditis usually has a thyrotoxic phase with high T4/T3 and low TSH before possibly entering a hypothyroid phase, so the pattern described is less typical. Toxic multinodular goiter also causes hyperthyroidism, not this hypothyroid picture.

Low T3 and T4 with an elevated TSH shows primary hypothyroidism: the thyroid gland isn’t producing enough hormone, so the pituitary raises TSH to try to stimulate it. The most common autoimmune cause in a middle-aged patient is Hashimoto thyroiditis, where immune-mediated destruction of thyroid tissue gradually reduces hormone synthesis. This fits with weight gain and depressive symptoms, and often with a non-tender, possibly enlarged thyroid and antibodies against thyroid peroxidase.

Graves disease, in contrast, would elevate thyroid hormones with a suppressed TSH. Subacute thyroiditis usually has a thyrotoxic phase with high T4/T3 and low TSH before possibly entering a hypothyroid phase, so the pattern described is less typical. Toxic multinodular goiter also causes hyperthyroidism, not this hypothyroid picture.

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