25th August 2020

A 54-year-old gentleman presented to the GP with a 1-month history of tremor, diarrhoea, weight loss and palpitations

A 54-year-old gentleman presents to the GP with a 1-month history of tremor, diarrhoea, weight loss and palpitations. He has a previous history of angina, asthma and hypertension. He has no known drug allergies, and he takes GTN spray, beclomethasone inhaler, salbutamol inhaler and ramipril. As well as the occasional ibuprofen for back pain. He does not report any increase in the frequency of his anginal attacks since the start of these symptoms. Physical examination reveals a diffuse goitre, fine tremor, tachycardia and profuse sweating. The GP orders some tests with the results as shown below:

• TSH: Low
• Serum-free T4: High
• TSH-receptor antibodies: Negative
• Anti-TPO antibodies: Positive

Based on the clinical findings and blood results, what should be the management plan for this gentleman?

Select the SINGLE most appropriate option from the list below.