Q. A 54-year-old Sudanese man comes to the primary care clinic because of the hoarseness of his voice. The patient cannot remember when the hoarseness started; however, he believes it is worsening and has recently become associated with exertional breathing difficulty (dyspnea on exertion). He immigrated to the United States five years ago and currently works as a teacher in a charity school. Since arriving in the US, he has had weight gain. He specifically denies any anxiety, tremor, or heat sensitivity. His past medical history is unavailable. He never smokes or drinks alcohol. His vital signs are normal except for irregular tachycardia. Physical exam is unremarkable; specifically, his neck does not feel enlarged. Which of the following is expected in the examination of this patient?