A 57-year-old female complains of fatigue, muscle weakness, palpitations, nervousness, and insomnia for the last few weeks. She thought she was just experiencing stress from her husband's recent stroke 1 month ago

Question

There are no current medications. Past medical history includes cholecystecomy at age 45, D & C, age 50. On physical examination, the patient is afebrile, pulse 102, 18 breaths/min, BP 156/ 98. Physical examination reveals tremulousness and quadriceps weakness bilaterally +4/5.
Which of the following diagnostic tests is a priority in the work-up?
A. ACTH challenge test
B. TSH
C. Atrial fibrillation
D. Fasting blood glucose

Answer 1

ANS: B
Common signs and symptoms of hyperthyroidism include muscle weakness, nervousness, insomnia, tachycardia, increased sweating, moist skin, intolerance to heat, exophthalmos, weight loss, loose stools, hypertension, and hyperreflexia. In the elderly, the presenting symptom may be atrial fibrillation. Even though the physical examination may increase suspicions, measuring the thyroid hormones T3, free T4 and TSH confirms the diagnosis. The T3 and T4 levels are above normal, and the TSH level is below normal, sometimes to the point at which it is barely measurable.