question: Q:A 32-year-old woman presents to her primary care physician for recent onset headaches, weight loss, and restlessness. Her symptoms started yesterday, and since then she has felt sweaty and generally uncomfortable. The patient’s past medical history is unremarkable except for a recent viral respiratory infection which resolved on its own. The patient is not currently on any medications. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 110/min, respirations are 14/min, and oxygen saturation is 98% on room air. On physical exam, you see a sweaty and uncomfortable woman who has a rapid pulse. The patient demonstrates no abnormalities on HEENT exam. The patient’s laboratory values are ordered as seen below.
  
  Hemoglobin: 12 g/dL
  Hematocrit: 36%
  Leukocyte count: 8,500/mm^3 with normal differential
  Platelet count: 195,000/mm^3
  
  Serum:
  Na+: 139 mEq/L
  Cl-: 102 mEq/L
  K+: 4.4 mEq/L
  HCO3-: 24 mEq/L
  BUN: 20 mg/dL
  Glucose: 99 mg/dL
  Creatinine: 1.0 mg/dL
  Ca2+: 10.2 mg/dL
  TSH: .03 mIU/L
  AST: 12 U/L
  ALT: 10 U/L
  
  The patient is prescribed propranolol and proplythiouracil. She returns 1 week later complaining of severe fatigue. Laboratory values are ordered as seen below.
  
  Hemoglobin: 12 g/dL
  Hematocrit: 36%
  Leukocyte count: 8,500/mm^3 with normal differential
  Platelet count: 195,000/mm^3
  
  Serum:
  Na+: 139 mEq/L
  Cl-: 102 mEq/L
  K+: 4.4 mEq/L
  HCO3-: 24 mEq/L
  BUN: 20 mg/dL
  Glucose: 99 mg/dL
  Creatinine: 1.0 mg/dL
  Ca2+: 10.2 mg/dL
  TSH: 6.0 mIU/L
  AST: 12 U/L
  ALT: 10 U/L
  
  Which of the following is the best next step in management?? 
  {'A': 'Decrease dose of current medications', 'B': 'Discontinue current medications and add ibuprofen', 'C': 'Discontinue current medications and add T4', 'D': 'Discontinue medications and add T3', 'E': 'Discontinue current medications'},