A 40 year old woman who complains of neck pain radiating to the jaw, sweating, palpitations, weight loss, and malaise. On exam, you palpate a diffuse tender mildly enlarged goiter. Review of systems is positive for a recent upper respiratory tract infection. She has a mild anemia and leukocytosis. ESR is markedly elevated. You schedule a nuclear exam for her, which is shown below.
By the time the patient follows up after the test, she says her symptoms have changed completely. Now, she is feeling depressed, lethargic, cold, and constipated.
Challenge: What's your diagnosis?
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