Marie A Savard MD

Solve the Medical Riddle: Her Hands Have Started Trembling, and Her Voice Is Shaky, First Week

Editor’s note: Welcome to our thirdAGE feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

We’ll start this week by letting you know what the patient told her PCP and how the doctor proceeded with the examination. Next week, the PCP will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!

The Patient Reports Her Symptoms

Patty is worried because her hands have started trembling and her voice is shaky.

As always in thirdAGE Medical Riddles, the doctor uses the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll learn what Patty told the PCP:

“After I turned 50 a year ago, my left hand started shaking a little every now and then. It’s my dominant hand. I was having trouble steadying it to sign checks. I also began having some trouble holding my coffee cup. I even spilled it once. My husband noticed the shaking about the same time I did. However, it was so subtle that we weren’t worried. But in the past few months, I’ve noticed a tremor in my right hand as well. Not only that, but my daughter mentioned that my voice sounded a little shaky when we were doing FaceTime with her and my grandchildren. I didn’t hear the voice tremor myself although my husband agreed with my daughter. Now I’m terrified that something is really wrong. I can’t get my eye makeup on straight any longer! I can still drive, thank goodness, but I’m afraid this might progress. When I was in grade school, I had a teacher with shaky hands and voice. Also, her head kept turning from side to side. A lot of the kids thought she was funny, but she freaked me out. I never learned what was wrong with her. I always had in the back of my mind that I would end up like that. Now my fear seems to be coming true! I hope you’ll tell me this is nothing serious and help me find a cure.”


Patty had no history of thyroid disease (high or low), and no history of autoimmune disease. She was taking no new medications except hydrochlorothiazide (HCTZ) for mild high blood pressure. She was not under more stress than usual other than her worry about how the tremor might affect her job as legal secretary, and embarrassment at the thought of people noticing the tremor.

Family History: Her father had mild hand shake she believes when he drank coffee but she doesn’t recall whether his head or voice were affected. He died of a heart attack fairly young in his 60’s.