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The Anxious Heart: Hyperthyroidism

Take a history from a patient presenting with anxiety and palpitations to uncover the systemic symptoms of hyperthyroidism.

  1. 1
    Review Clinical Case
  2. 2
    Patient Encounter
  3. 3
    Self Evaluation(optional)
  4. 4
    Feedback

Review Clinical Case

1. Learning: Recognizing Hyperthyroidism

Hyperthyroidism, or an overactive thyroid, speeds up the body's metabolism. It often presents with symptoms that can mimic a primary anxiety disorder, such as anxiety, irritability, and palpitations. The key to diagnosis is a thorough review of systems to find other clues that point to a systemic, metabolic cause.

Classic symptoms to screen for:

  • General: Unintentional weight loss despite increased appetite, heat intolerance, sweating.
  • Cardiovascular: Palpitations, racing heart (tachycardia).
  • Neurologic: Anxiety, irritability, insomnia, fine tremor.
  • GI: More frequent bowel movements or diarrhea.
  • Skin/Hair: Thinning hair, warm/moist skin.

2. Scenario Briefing

Your Objective

Your objective is to take a detailed history from Maria, a 30-year-old woman presenting with anxiety and palpitations. You must perform a comprehensive review of systems to differentiate a primary anxiety disorder from the systemic symptoms of hyperthyroidism.

Patient Background

Maria is a 30-year-old woman who comes to your primary care clinic because she's been feeling "anxious and on edge" for the past few months, and has been having episodes where her heart races.

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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Find a quiet spot with a good internet connection. Speak naturally — it’s fine to pause to think.

After completing this scenario, you will be able to:

  • Differentiate symptoms of hyperthyroidism from those of a primary anxiety disorder through a comprehensive history.
  • Conduct a targeted review of systems to identify systemic signs of a metabolic disorder in a patient presenting with anxiety.
  • Formulate a differential diagnosis for new-onset anxiety and palpitations that includes both endocrine and psychiatric etiologies.

A patient presents with new-onset anxiety, irritability, and palpitations. Which of the following additional symptoms is most specific for hyperthyroidism over a primary anxiety disorder?

When considering the differential diagnosis for a young patient with palpitations and anxiety, which of the following organ systems is most crucial to evaluate in the review of systems?

Which of the following historical findings would decrease your suspicion for hyperthyroidism in a patient with anxiety?