A 44-Year-Old Man Comes to the Clinic Due to Increasing

A 44-year-old man comes to the clinic due to increasing fatigue, trouble sleeping, and palpitations.  He has lost 9 kg (20 lb) over the last year despite eating well.  The patient says he is under a lot of pressure at work but cannot think of any other precipitating factors for his insomnia.  He has no other medical problems and takes no medications.  The patient does not use tobacco, alcohol, or illicit drugs.  His mother has a history of a thyroid problem.  Blood pressure is 140/80 mm Hg and pulse is 108/min.  On physical examination, the thyroid is diffusely enlarged.  His serum free thyroxine level is elevated and TSH level is decreased.  He is found to have a positive assay for thyrotropin receptor antibodies.  If present, which of the following additional findings would be most specific to the underlying cause of this patient's hyperthyroidism?

A) Atrial fibrillation
B) Decreased bone mineral density
C) Heat intolerance
D) Skin thickening and induration over the shin
E) Tremor of the outstretched hands

Correct Answer:

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