Question

Which one of the following features may NOT be seen in hypothyroidism?

• A. Cold intolerance
• B. Deafness
• C. Pericardial effusion
• D. Pretibial myxoedema

Hint:

Pretibial myxoedema belongs to Graves' disease, a hyperthyroid condition.

Answer 1

The Correct Option is D

This question picks out the one option that does not fit the usual features of an underactive thyroid.

1. Cold intolerance: A hallmark of hypothyroidism, since a slower metabolism generates less heat.
2. Deafness: Can occur in hypothyroidism from myxoedematous swelling around the inner ear structures, and is also seen in some congenital forms of the condition.
3. Pericardial effusion: A recognized complication of hypothyroidism known as myxoedema heart, where protein rich fluid gathers around the heart.
4. Pretibial myxoedema: This one is a trap. Despite the shared name, it results from an autoimmune attack on skin fibroblasts over the shins driven by TSH receptor antibodies, and it belongs to Graves' disease, a hyperthyroid condition, not hypothyroidism.

Three of the four choices trace back to the slowed metabolism and fluid retention of hypothyroidism, but pretibial myxoedema actually belongs to the opposite disease, hyperthyroidism.

Let's summarize:

• Cold intolerance, deafness, and pericardial effusion are all genuine hypothyroid features.
• Pretibial myxoedema is caused by Graves' disease related autoimmunity and belongs to hyperthyroidism, not hypothyroidism.

So pretibial myxoedema is the feature that may not be seen in hypothyroidism.