09-03-2008, 01:34 PM
_ 67-year-old man is evaluated for palpitations, heat intolerance, and a 2.4-kg (5-lb) weight loss over 1 month. The patient has a history of dilated cardiomyopathy and congestive heart failure, and his medications include warfarin, digoxin, lisinopril, and carvedilol. On physical examination, the pulse is 82/min and regular, the thyroid gland is twice normal size, and he has a moderate resting tremor. Laboratory testing shows free T4 3.1 ng/dL (39.7 pmol/L) and serum thyroid-stimulating hormone