A 65 year old lady presents with fine tremors of both hands for 2 years. The tremors were postural in nature, more pronounced with stress, and absent at rest. Her handwriting has worsened to the point where she is unable to write legibly anymore. Her medical history is unremarkable and she is not on any medications.
TSH: 1.0 mIU/L (0.4 – 4.0) FT4: 15 pmol/L (8 - 27)
Total bilirubin, ALT, AST, ALP, GGT, INR, S. Albumin: all within normal parameters.
Blood urea: 15 mg/dL (3 - 20) S. Creatinine: 0.6 mg/dL (0.5 - 1.2)
Nerve conduction studies of the upper limbs are completely normal.