Make the Diagnosis: Summer 2019

A 5-year-old boy presents for an annual well visit. His parents report he has recently had an increased appetite along with increased energy levels and that he constantly complains about being warm with occasional complaints that his heart is “beating fast.” He is otherwise happy and interactive with his siblings and friends, but has had increased moodiness and some behavioral outbursts. With the exception of mild, intermittent asthma, his past medical history is unremarkable, including his birth history. Family history is positive for multiple members having autoimmune disorders.

On exam, he is flushed and his eyes are somewhat prominent. His heart rate is elevated at 130 beats per minute and his skin is warm and sweaty. His neck is full, but you do not see an obvious outline to his thyroid and there are no abnormal lymph nodes. He is breathing comfortably with clear breath sounds bilaterally. His abdominal exam is normal, no hepatosplenomegaly or masses.