14th February 2025

A 56-year-old woman is seen in ambulatory care after experiencing anxious ruminations, chest discomfort and sweaty palms for three weeks.

A 56-year-old woman is seen in ambulatory care after experiencing anxious ruminations, chest discomfort and sweaty palms for three weeks. This began shortly after she was the victim of a mugging on the street she lives on.

She has a background of hyperthyroidism and is worried that this is no longer adequately controlled, as symptoms are similar to those of her initial presentation. She also has a background of seborrhoeic dermatitis, atrial fibrillation, high cholesterol and peripheral vascular disease. She takes propylthiouracil, bisoprolol, apixaban, atorvastatin, and ketoconazole shampoo.

She visits her GP. Observations: RR 18, Sa02 95% on RA, HR 65, BP 113/78, T 37.1

Thyroid function tests are performed, showing the following:

TSH 2.6 mU/L² (0.4-4)

Free T4 15.1 pmol/L (9-24)

What is the most likely cause of her symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.