A nurse practitioner is considering additional workup for a patient with suspected anxiety disorder. Which of the following would be an appropriate initial test?
Group of answer choices
- Thyroid-stimulating hormone
- Electroencephalogram
- Magnetic resonance imaging of the brain
- Erythrocyte sedimentation rate
The correct answer is: Thyroid-stimulating hormone (TSH)
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Explanation:
When evaluating a patient with suspected anxiety disorder, it is essential to rule out medical conditions that can mimic or exacerbate anxiety symptoms. The most appropriate initial test is:
- Thyroid-stimulating hormone (TSH) – To assess for hyperthyroidism, which can present with anxiety, tachycardia, and tremors.
Why Not the Others?
- Electroencephalogram (EEG): Only indicated if seizure activity (e.g., temporal lobe epilepsy) is suspected.
- MRI of the brain: Reserved for cases with focal neurologic deficits or concern for structural abnormalities (e.g., tumor).
- Erythrocyte sedimentation rate (ESR): A nonspecific marker of inflammation; not useful for anxiety workup unless autoimmune/infectious causes are suspected.
Key Point:
Anxiety disorders are clinical diagnoses, but TSH screening is a routine initial test to exclude hyperthyroidism. Other tests are only needed if history/exam suggests alternative causes.
Thus, TSH is the most appropriate initial lab test.
