The symptoms you've described, including the white, brittle nails that seem to lift off the nail beds—known medically as onycholysis—and episodes of feeling warm and sweating, when considering the complete clinical picture, especially the report of the patient appearing thin and mildly anxious, raise the suspicion for hyperthyroidism. The past medical history of intravenous drug use might not be directly relevant to the current symptoms, but it is important to keep a thorough background as certain conditions may have long-term effects or predispose individuals to other illnesses.
Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine, which can accelerate your body's metabolism, causing unintentional weight loss and a rapid or irregular heartbeat. It can also cause thinning of the hair and nails, warm, moist skin, and changes in the menstrual cycle.
Given the potential seriousness of thyroid disorders, I would suggest the following diagnostic approach:
1. **Clinical Examination:** A thorough clinical examination, particularly looking for signs such as a goiter (enlargement of the thyroid gland in the neck), tremor, or ophthalmic changes.
2. **Blood Tests:** I would order a thyroid function test to measure levels of Thyroid-Stimulating Hormone (TSH) and thyroxine. In hyperthyroidism, we would expect to find a low TSH and high free T4 (thyroxine) level.
3. **Thyroid Scintigraphy or Ultrasound:** Depending on the results, an imaging study might be needed to evaluate the thyroid gland further.
As a physician, I cannot prescribe medications without a proper diagnosis confirmed through testing, but should the diagnostic process confirm hyperthyroidism, there are various treatment modalities, including beta-blockers to manage symptoms, antithyroid medications (such as methimazole or propylthiouracil), radioactive iodine therapy, or in some cases, surgery.
I strongly recommend that this patient consult with an endocrinologist or her primary care provider for evaluation and to initiate the proper diagnostic workup. It's also crucial to evaluate the condition in the context of her overall health and any other symptoms she may be experiencing. If hyperthyroidism is confirmed, the treatment plan should be tailored to the patient's individual needs.
Remember, this guidance is based on the information available in the scenario provided, and actual medical care should be conducted in a personal consultation involving a comprehensive assessment by a healthcare professional.