Approach to hyperthyroidism and thyrotoxicosis Quiz: Ace Your Exams

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A 62-year-old woman presents to the primary care office for evaluation of weight loss and excessive sweating. She has lost 8 pounds in the last two months despite eating more than usual. She has normal bowel movements. She has had a goiter for many years, but her thyroid function tests have been normal. She does not take any medications. A cardiac catheterization was performed four months ago following an episode of acute chest pain that revealed a 30% occlusion of the left anterior descending artery. Temperature is 37.0°C (98.6°F), pulse is 102/min, respiratory rate is 20/min, and blood pressure is 152/84 mmHg. BMI is 20. On exam, she appears anxious and her skin is warm. No adenopathy is appreciated. A non-tender goiter is palpable at the anterior neck. Labs are obtained with results detailed below. Which of the following tests should be ordered next?

 Laboratory value  Result  Reference range 
 TSH  0.21 mIU/L  0.5-5 mIU/L 
 Serum free T4  10.1 ng/dL  0.9-2.3 ng/dL 
 TSH Receptor antibodies  Negative  Negative

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