1. What is the level of thyroid function in this patient? Are additional diagnostic tests necessary to define the level of thyroid function and if so which one(s)?

• Hyperthyroid. 
• Yes, TSH.

2. What are the symptoms that made you consider that diagnosis?

3. What physical findings supported the diagnosis?

4. Which lab data supported the diagnosis?

Explain-Hypothalamic-Pituitary-Thyroid axis and interrelationship.

6. What additional aspects of the history and physical examination could provide relevant information to help in the clinical diagnosis?

7. What is the most likely cause of this patient's illness? What tests are necessary to confirm its cause? Are antithyroid antibodies helpful?

• Toxic multinodular goiter.
•  A thyroid scan to verify the autonomy of the thyroid nodules.
•  No.

8. What are the treatment options?

Radioactive iodine or surgery with antithyroid drug and iodine pretreatment