She cannot identify stressors that may be causing these symptoms. She also admits to increased sweating, intolerance to heat, and insomnia associated with her anxiety. Her menses were always regularly spaced at 28 days, until the past 3 months when they became sporadic and unpredictably irregular. She is anxious with visible hand tremors. Her skin is warm, moist, and smooth without lesions or depigmentation.
Eye exam reveals exophthalmos, lid lag, proptosis and poor pupillary convergence bilaterally.
The thyroid is diffusely enlarged, nontender and symmetrical with a bruit on ausculation. No nodules, masses or jugular venous distention noted. Lungs are clear to auscultation. Without masses or striae. Extremities are warm, moist, without cyanosis or edema.