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A 60-Year-Old Caucasian Male Complains of Difficulty Swallowing Which Has

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A 60-year-old Caucasian male complains of difficulty swallowing which has rapidly worsened within the last two weeks. The patient noticed a swelling on the front of his neck that started growing for the past month. He was otherwise in his normal state of health. He also complains of fevers, night sweats, and weight loss. He denies cough, dyspnea, chest pain, headache, abdominal pain, skin rashes, and urinary symptoms. His past medical history is significant for mild hypertension treated with hydrochlorothiazide, as well as a small goiter for the past 10 years. He states that his blood tests for thyroid hormone levels were normal, and he has never taken thyroid hormone preparations in the past. His family history is positive for a mother and several other family members with hypothyroidism. He has a smoking history of 15-pack-years but quit 25 years ago. He does not drink alcohol. Physical examination reveals a large, irregular, non-tender swelling over the inferior aspect of his neck. The lower margin of this swelling can not be palpated. He develops facial plethora and venous engorgement of the neck veins after raising his arms above the shoulder for 20 seconds. CBC and basic chemistries are normal. TSH is 26.0 μU/ml (normal 0.35-5.0 μU/ml) and free T4 is 0.2 μg/dl (normal 0.8 to 1.8 μg/dl) . Antithyroid peroxidase antibodies are detected in very high titers. What is the most likely diagnosis in this patient?

Definitions:

Stronger Side

A term often used in physical therapy or fitness to refer to the more dominant or physically capable side of a person's body.

Good Leg

A non-medical term generally referring to the stronger or uninjured leg of an individual who has one leg that is weaker or has been injured.

Target Heart Rate

A desired range of heartbeats per minute achieved during exercise to gain cardiovascular benefits while minimizing risks.

Exercise Program

A planned, structured set of physical activities designed to achieve specific fitness or health goals.