41 year old man with weight loss and palpitations

Physical Examination

  • General appearance: He is slim and appears somewhat anxious. His hands are sweaty, and hand tremors are noted.

  • Vital signs:
  • Temperature: 37.2° C
  • Pulse: 108 beats/min
  • Respirations 22/min
  • BP 124/80 mm Hg

  • Skin: Hands and back are sweaty. No rash, erythema, or skin lesions.

  • HEENT: Both eyes are slightly protruding, conjunctivae are red, but there is no eye discharge. Fundi normal bilaterally. He has normal eye movements. There is bilateral, nontender thyroid enlargement without any nodules. No cervical lymphadenopathy. A bruit is noted on auscultation of his thyroid.

  • Pulmonary: Chest is clear on auscultation.

  • Cardiovascular: Heart rate is 108 beats/min and regular. Normal heart sounds.

  • Gastrointestinal: Unremarkable, including normal rectal exam; stool is negative for occult blood.

  • Genitourinary: Unremarkable

  • Musculoskeletal: No muscle wasting or fasciculations. Joints are normal.

  • Neurologic: Alert and oriented to person place and time. There is slightly reduced proximal muscle tone, but quadriceps strength testing is 5/5 bilaterally; testing of other muscles is normal. Reflexes are brisk and symmetric. Sensation to touch is normal. Cranial nerves II to XII intact. Balance and gait normal.

  • Mental status: He appears agitated and restless but responds appropriately to all questions and commands. No flight of ideas, pressured speech, or hallucinations.