An unexpected finding in a case of thyroid malignancy

A case of suspected thyroid malignancy is made more challenging by some unexpected biochemical findings

John is a 40-year-old CEO who attends for a general check-up. John generally enjoys good health and has no past history of note.

He reports he is tired most of the time, which he puts down to his long work hours.

He has no features of pervasive mood disorder, and systems review reveals no red flags or localising symptoms.

John takes no regular medications, has no known allergies and has no family history of note.

Examination

On examination, John appears slightly

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