Laboratory report: elevated serum free t4; low serum TSH level. Which of the following is the MOST likely diagnosis?
A. Primary hypothyroidism
B. Secondary hypothyroidism
C. T3 thyrotoxicosis
D. Graves disease
E. Chronic Hashimoto's thyroiditis
Answer: D, Graves disease
High T4 (hyperthyroid), with a low TSH indicates that the pituitary is working normally, and the thyroid is hyperactive, i.e. Grave's disease. Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.
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