Differential Diagnosis
The provided lab results suggest a complex thyroid and liver condition. Here's a differential diagnosis organized into the requested categories:
- Single most likely diagnosis
- Graves' disease with thyroiditis and liver involvement: This diagnosis is likely due to the presence of high free T3 and free T4, low TSH, and high TPO and TG antibodies, which are indicative of autoimmune thyroid disease. The elevated LFTs, total bilirubin, and alkaline phosphatase suggest liver involvement, possibly due to the systemic effects of Graves' disease or a concurrent condition.
- Other Likely diagnoses
- Hashitoxicosis: This condition is characterized by the presence of high thyroid hormones and low TSH, along with positive TPO and TG antibodies. The liver enzyme elevations could be due to the systemic effects of the condition or a concurrent liver disease.
- Subacute thyroiditis: This condition can cause elevated thyroid hormones, low TSH, and elevated liver enzymes. However, the presence of high TPO and TG antibodies makes this diagnosis less likely.
- Painless thyroiditis: Similar to subacute thyroiditis, painless thyroiditis can cause elevated thyroid hormones and low TSH. The liver enzyme elevations could be due to the systemic effects of the condition or a concurrent liver disease.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Thyroid storm: Although the patient's lab results do not necessarily indicate a thyroid storm, this condition can be life-threatening and should be considered in any patient with elevated thyroid hormones and systemic symptoms.
- Liver failure: The elevated LFTs, total bilirubin, and alkaline phosphatase suggest significant liver dysfunction. If left untreated, liver failure can be fatal.
- Rare diagnoses
- Struma ovarii: This rare condition involves the presence of thyroid tissue in the ovaries, which can produce thyroid hormones and cause hyperthyroidism. However, this diagnosis would not explain the liver enzyme elevations.
- Familial dysalbuminemic hyperthyroxinemia: This rare genetic disorder causes elevated levels of thyroid hormones due to abnormal binding proteins. However, this diagnosis would not explain the liver enzyme elevations or the presence of TPO and TG antibodies.