Family Medicine 05: 30-year-old female with palpitations

What is the most common cause of hyperthyroidism in adults and children? Choose the single best answer. The best option is indicated below. Your selections are indicated by the shaded boxes. A. Drug-induced hyperthyroidism B. Excessive iodine ingestion C. Thyroiditis D. Toxic diffuse goiter (Graves disease) E. Toxic nodular goiter (thyroid nodules)

The correct answer is D.

What are the top five diagnoses on your differential at this point? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. Anemia B. Anxiety/panic disorder C. Aortic stenosis D. Cardiac dysrhythmias E. Dehydration/hypovolemia F. Drug abuse (including caffeine) G. Hyperthyroidism

The correct answers are A, B, D, F, G.

Which of the following are common symptoms in patients with hypothyroidism? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. Cold intolerance B. Double vision C. Fatigue D. Heavy periods E. Pedal edema F. Weight gain

The correct answers are A, C, D, E, F.

What other tests could be done to find out the etiology of her hyperthyroidism? Select all that apply. A. Anti-thyrotropin receptor antibodies B. MRI of the thyroid gland. C. Radioactive iodine uptake test and scan D. Thyroid ultrasound

The correct answers are A, C.

What are the common signs and symptoms of hyperthyroidism? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. Constipation B. Depression C. Fatigue D. Heat intolerance E. Heavy periods F. Hyperreflexia G. Sweating H. Tachycardia/Palpitations I. Tremor J. Weight loss

The correct answers are B, C, D, F, G, H, I, J.

Which of the following are true statements about eye involvement in Graves disease? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. More than 50% of patients with Graves disease have clinically significant eye problems. B. Primary symptoms of the eye manifestations of Graves disease, when they occur, are related to corneal irritation from the eyelid retraction. C. The eye manifestations of Graves disease always happen when the level of thyroid hormones are high. D. The most common manifestations of Graves ophthalmopathy are eyelid retraction and exophthalmos. E. Treatment of the hyperthyroidism improves the eye manifestations of Graves disease. F. While most of the time the eye signs and symptoms are bilateral, they can be unilateral.

The correct answers are B, D, F.

Two possible initial treatments include radioactive iodine and anti-thyroid medication. Which treatment would you choose?

The radioactive iodine treatment makes the most sense for Ms. Waters' lifestyle. Choosing the right treatment depends on the patient's personal values and life situation.

Understanding the importance of knowing if a patient is pregnant in this situation, how would you approach this history? Would you accept this history as sufficient or would you go ahead and obtain a pregnancy test?

There is no single correct answer in this situation. Many physicians would consider the risks of obtaining a urine pregnancy test extremely low when weighed against the high stakes of inadvertently proceeding with radioactive iodine during an unknown first-trimester gestation. Certainly ordering a urine pregnancy test in the face of a patient telling you they have never had sex with males has the potential to be perceived as less than trusting.

Which of the following can cause an enlarged thyroid, also known as goiter? Select all that apply. The best options are indicated below. Your selections are indicated by the shaded boxes. A. Cancer B. Hyperthyroidism C. Hypothyroidism D. Lack of iodine E. Nodules F. Pregnancy G. Thyroiditis

All answers are correct

For each of the following categories, list examples of conditions that can cause palpitations: Cardiovascular Psychiatric Medications Substances Endocrinologic Hematologic Infectious

Cardiovascular: Arrhythmia, cardiomyopathy, hypovolemia Psychiatric: Anxiety, panic attacks Medications: Caffeine, stimulants, theophylline, and albuterol use Substances: Tobacco, caffeine, alcohol intoxication or withdrawal, cocaine, amphetamines Endocrinologic: Hyperthyroidism, pheochromocytoma, hypoglycemia Hematologic: Anemia Infectious: Febrile illness

Based on what you know about the patient so far, write a one- to three-sentence summary statement to communicate your understanding of the patient to other providers.

Ms. Waters is a 30-year-old female who presents with several weeks of palpitations with associated mild dyspnea. She also notes a five-pound unintentional weight loss, oligomenorrhea, increased sweating, and loose stools during this period. She reports minimal caffeine intake and reports no use of drugs or alcohol, but reports high levels of work-related stress. The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes: Epidemiology and risk factors: 30-year-old woman Key clinical findings about the present illness using qualifying adjectives and transformative language: Several weeks of palpitations associated with mild dyspnea Five-pound unintentional weight loss Change in menses Increased sweating Loose stools Minimal caffeine intake Reports no use of drugs and alcohol High levels of work-related stress