A 40-Year-Old Man Comes to the Physician Because of Palpitations

A 40-year-old man comes to the physician because of palpitations and a 5.4-kg (11.9-lb) weight loss over the past 3 months. He appears anxious. His pulse is 104/min and blood pressure is 148/101 mm Hg. He has no other medical problems and takes no medications. Physical examination shows warm skin, mild tremor, and an enlarged thyroid gland. 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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