Thanks for your question on Healthcare Magic. I can understand your concern. By your history and description, possibility of hyperthyroidism is more likely. If symptoms are not controlled with propranolol and methimazole, you should first increase the dose of methimazole. Get done thyroid scan to know the uptake. If iodine uptake is high, biopsy is needed to rule out malignancy. Hope I have solved your query. I will be happy to help you further. Wishing good health to your patient. Thanks.