Professional and Linguistic Assessments Board (PLAB) Practice Exam

In hyperthyroidism with a tender goiter, what is the most likely underlying condition?

1. Chronic thyroiditis

2. Subacute thyroiditis

3. Thyroid cancer

4. Graves' disease

The correct answer is: Subacute thyroiditis

In hyperthyroidism accompanied by a tender goiter, the most likely underlying condition is subacute thyroiditis. This condition is often characterized by inflammation of the thyroid gland, which can lead to pain and tenderness in the neck area. The inflammation typically arises due to viral infections and results in hormone leakage from damaged thyroid follicles, causing hyperthyroidism. In this scenario, the tender goiter indicates that there is an inflammatory process occurring in the thyroid tissue, which aligns with the features of subacute thyroiditis. Patients usually experience fever, malaise, and a self-limiting course of hyperthyroid symptoms as the thyroid heals and hormone levels eventually normalize. Other conditions mentioned do not typically present with tenderness of the goiter. Chronic thyroiditis is generally less painful and is often associated with Hashimoto’s thyroiditis, where the thyroid might be enlarged but not tender. Thyroid cancer can present as a nodular mass but is usually not associated with tenderness or acute symptoms. Graves' disease is an autoimmune condition and the most common cause of hyperthyroidism; however, it typically leads to a non-tender enlargement of the thyroid. Thus, subacute thyroiditis is the best fit given the symptoms in this scenario.