An understandable first impression
She described nervousness, insomnia, heat intolerance and shaky hands during a stressful period. Initial treatment for anxiety gave little benefit.
One persistent sign
Even when relaxed in clinic, the resting heart rate remained high. She had fine tremor, warm skin and recent unintentional weight loss.
The twist
Thyroid testing showed thyrotoxicosis. The emotional symptoms were real, but they were being driven by an endocrine disorder.
Take-home message
Anxiety-like symptoms deserve basic physical assessment. Persistent tachycardia, heat intolerance, weight loss or tremor should prompt consideration of hyperthyroidism.
Diagnostic principle: do not let the first plausible label stop the search when an important detail does not fit.
Educational note: This is a teaching composite, not a substitute for patient-specific diagnosis or treatment. Real patients require direct clinical assessment and appropriate investigations.