Associates' Presentations
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Undiagnosed Thyrotoxicosis In Presence Of Other Medical Problems
Ashish Verma, M.D., Nikhil Shah, M.D., Medical College of Wisconsin, Milwaukee, WI
A 41 year-old female with history of Multiple Sclerosis, Rheumatoid Arthritis, neurogenic bladder and muscle wasting and hyperreflexia and joint deformity secondary to her Multiple Sclerosis and Rheumatoid Arthritis comes to ER for blood in the urine. While in the ER she was noted to have a heart rate in the 180s and was Supraventricular Tachycardia. Subsequent history and physical reveals patients' normal heart rate is 140, approx. 30 pound weight loss in past three months despite strong appetite, severe heat intolerance, depression, anxiety, exophthalmos, hyperreflexia, lid lag, tremor... all classic signs and symptoms of thyrotoxicosis. This is her third hospitalization in 6 months which include neurological evaluations for tremors and hyperreflexia thought to be due to complications of Multiple Sclerosis, Pulmonary embolism evaluation for persistent tachycardia, and anxiety and depression thought to be due to her debilitation and other social situations like divorce.
Classic full-blown thyrotoxicosis is generally made by history and physical exam. These findings would include nervousness, fatigue, palpitations, exertional dyspnea, weight loss, heat intolerance, irritability, tremor, muscle weakness, decreased menstrual flow in women, sleep disturbance, increased perspiration, change in appetite, photophobia, and diplopia. (I) This case report describes how classic findings of thyrotoxicosis were missed over many months in the presence of other chronic medical conditions. In conclusion, hyperthyroidism is a great masquerader presenting as various other medical conditions. Unless the clinician suspects the diagnosis or is looking for the disease, the disease may be missed despite obvious signs an symptoms in the presence of other chronic medical illnesses.
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