A 45-year-old woman presents with new-onset anxiety, palpitations, heat intolerance, and weight loss. Which investigation is most important before diagnosing a primary anxiety disorder?
- A EEG
- B Serum cortisol
- C Serum TSH ✓
- D MRI brain
Correct answer: C. Serum TSH
Explanation
Hyperthyroidism commonly mimics generalized anxiety disorder with palpitations, tremor, heat intolerance, and weight loss. TSH is the recommended screening test in new-onset anxiety per guidelines. Missing a medical cause like hyperthyroidism before diagnosing a primary psychiatric disorder is a fundamental clinical principle emphasized in all standard texts.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.