03-28-2007, 04:03 AM
A previously healthy 32-year-old woman from a small rural town comes to your office complaining of extreme anxiety and palpitations on several occasions during the past week. She denies having had episodes like these before, and she also notes feelings of excessive warmth. Her past history is remarkable only for a normal pregnancy six years ago, and she takes no medications. Her pulse is 110/min and blood pressure is 145/80 mm Hg. Her skin is moist, and she has a rim of sclera visible above the iris when looking straight ahead. She has a non-palpable thyroid and a 2/6 early systolic murmur on cardiac examination. There is a fine tremor in her hands and she has brisk, hyperactive reflexes bilaterally. Serum thyroid-stimulating hormone is 0.2 mcU/mL. Her child, who has also been subsequently healthy, accompanies his mother to the clinic today. During the visit, you notice that the child is extremely active and on examination is himself tremulous with a wide-eyed stare. As the town's family physician, you have seen several similar cases within the past month. Which of the following is the most likely explanation for these findings?
A. Accidental ingestion of thyroid hormone
B. Infectious thyroiditis
C. Over-supplementation with dietary iodine
D. Panic attacks
E. Self-administration of thyroid hormone
A. Accidental ingestion of thyroid hormone
B. Infectious thyroiditis
C. Over-supplementation with dietary iodine
D. Panic attacks
E. Self-administration of thyroid hormone