Approach to hyperthyroidism and thyrotoxicosis Quiz: Ace Your Exams

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A 42-year-old woman presents to her primary care office due to one month of diarrhea refractory to over-the-counter medications and dietary modifications. She has also been feeling hot most of the time regardless of the temperature and is severely anxious. She has not had nausea or abdominal pain. Temperature is 37.0°C (98.6°F), pulse is 90/min, respiratory rate is 18/min and blood pressure is 148/82 mmHg. On exam, the skin is warm and moist. Exophthalmos is noted and a non-tender goiter is palpated at the anterior neck. Lungs are clear to auscultation bilaterally. Abdomen is soft and nontender with hyperactive bowel sounds. No edema is present in the lower extremities. Laboratory results are shown below. Which of the following is the most likely diagnosis?  

 Laboratory value  Result
 TSH  0.19 mIU/L 
 Serum free T4  11.2 ng/dL 
 TSH receptor antibody  Positive 
 Thyroglobulin antibody  Negative 
 Thyroid peroxidase antibody  Negative 
 

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