A 45-year-old woman complains of a two-month history of fast heart rate and palpitations.

Chart

A 45-year-old woman comes into your office complaining of a two-month history of fast heart rate and palpitations. She also notes sweating and nervousness. In addition, she complains of a swelling in the lower portion of her neck. Examination reveals a diffuse goiter.

Thyroid Stimulating Hormone (TSH) is reduced. Thyroid levels t3 and t4 are elevated.