20th August 2020

A 40-year-old primary school teacher comes to visit her GP after noticing a slight discomfort in her neck

A 40-year-old primary school teacher comes to visit her GP after noticing a slight discomfort in her neck whilst talking for prolonged periods of time in the class, or whilst swallowing food and drink. She states that she feels well in herself, has a reasonable appetite and is sleeping well. She also has a regular routine of opening her bowels and has not experienced any other symptoms. On clinical examination, the GP noted two solitary well defined lumps in the patient’s neck just to the right of the midline, and one lump similarly on the left hand side. The patient herself had only been aware of the lump on the left hand side. The GP organised a set of blood tests in order to investigate further which are given:

T₄  78mmol/L, TSH 3.1 mu/L, Na⁺ 137 mmol/L, K⁺ 3.9 mmol/L, Ca²⁺ 2.38 mmol/L, PTH 5.4 pmol/L, Glucose 5.8 mmol/L

For the patient above, please select the SINGLE most likely diagnosis based on the clinical history and/or biochemical tests provided. Select ONE option from the list above. 

You may use the following reference ranges:

• Serum total thyroxine, T₄: 70 – 140 mmol/L
• Serum Thyroid stimulating hormone, TSH: 0.5 – 5.7mu/L
• Serum sodium, Na⁺: 135 – 145mmol/L
• Serum potassium, K⁺: 3.5 – 5.0 mmol/L
• Serum total calcium, Ca²⁺: 2.12 – 2.65 mmol/L
• Serum parathyroid hormone, PTH: 2 – 7 pmol/L
• Serum (fasting) glucose: 4 – 6 mmol/L