Rule Out / Past cases / Hypothyroidism
Rule Out case #3 · GentleHypothyroidism: a six-clue practice case
Read the clues in order and name the diagnosis as early as you can. Clues move from the patient’s story to the classic findings.
Play it as a game firstGuess before each clue unlocks, then share your score.The clues
Clue 1: A 38-year-old woman says she has been exhausted for months.
Clue 2: She has gained 6 kg without eating more and always feels cold.
Clue 3: She is constipated, and her skin and hair are dry.
Clue 4: Her menstrual periods have become heavier.
Clue 5: Her heart rate is 54, and her reflexes relax slowly.
Clue 6: TSH is high, free T4 is low, and anti-TPO antibodies are positive.
Show the diagnosis and takeaways
Diagnosis
Hypothyroidism (Hashimoto thyroiditis)
What gives it away
- Fatigue, cold intolerance, weight gain, constipation and dry skin all reflect a slowed metabolism.
- High TSH with low free T4 means the thyroid itself is failing; anti-TPO antibodies point to Hashimoto thyroiditis.
- Treatment is daily levothyroxine, adjusted to TSH.
Ran as Rule Out #3 (Tuesday, October 20, 2026).
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