Mary is a 34 year old female with no significant past histor…
Mary is a 34 year old female with no significant past history presenting to the clinic for “my heart feels like its racing and I can’t tolerate the heat.” Upon gathering history, she informs you for the past 3 months she has had the following: palpitations, unintentional weight loss, heat intolerance, anxiety/irritability, insomnia, frequent bowel movements, menstrual irregularities. She does not take any medications but does take caffeine supplements occasionally for energy. Vitals; BP 138/72, HR 112, RR 18, Temp 99.4. Exam: mild exophthalmos, lid lag present, diffuse non-tender goiter, thyroid bruit present. She is tachycardic with no murmurs with fine tremor of hands and hyperreflexia. labs show TSH
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