A 60 year old woman presents to a physician complaining of swelling in her neck. Her past medical history is significant for RA and sjögren syndrome. Physical examination reveals a mildly nodular, firm goiter. Total serum thyroxine(T4) is 10 mg/dL, and third generation thyroid stimulating hormone (TSH) testing shows a level of 1.2 mIU/mL. Antithyroid peroxidase antibody titers are high. Which of the following is most likely diagnosis? A. Gravès disease B. Hashimoto thyroiditis C. Subacute thyroiditis D. Euthyroid sick syndrome E. Silent lymphocytic thyroiditis.

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Hashimoto's Thyroiditis.

TFT normal Diffuse swelling/nodular not clear please USE TPO +ve autoimmune disease Can progress to hashimotos thyroiditis TPO can be +ve in Graves also

Thyroid USG
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I think E silentlymphocytic thyroiditis

Graves disease

B Hashimoto thyroiditis

Here is the picture.

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