Case Problem Statement
Regina Ricardo is a 65 y/o retired science teacher whose chief complaint is insomnia, nervousness, and fatigue for the last 2 or more months. She notes an increased number of daily bowel movements, heat intolerance, unintentional weight loss despite increased appetite and food intake. Physical exam reveals tachycardia, lid lag, mildly enlarged (45 gm) soft, non-tender thyroid with palpable ropey isthmus, hyperreflexia and coarse tremor upon extension of hands. FH is significant for a maternal grandmother who was stated to have “some sort of thyroid problem”.