A 76-year-old Caucasian woman presents for follow-up for previous skin cancers. 

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<p>A 76-year-old Caucasian woman presents for follow-up for previous skin cancers.</p><p>Her medical history includes AF, GORD, osteoporosis and diverticular disease.</p><p>She is taking a direct oral anticoagulant, esomeprazole, denosumab, beta blocker, ACEI and digoxin.</p><p>Her appearance is altered, due to the prominence of her eyes and visible weight loss.</p><p>On examination vital signs are unremarkable apart from a regular pulse rate of 110bpm and weight loss of 10kg in 12 months.</p><p>The thyroid is enlarged. There are thick scaly plaques bilaterally on the anterior shins, with non-pitting oedema.</p><p>There is bilateral proptosis with no evidence of ophthalmoplegia or pain with eye movement.</p>