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History of Present Illness:

A woman in her 60s with a history of irritable bowel syndrome, HTN and PSVT presents to the ED for 1 week of increasing anxiety, palpitation, and diaphoresis. She has not had any fever, chills. She denies having any dizziness or syncope. Patient wearing heart monitor, seen by cardiology and sent to for rapid heart rate.  treated with 6 and 12 of adenosine without relief.

Vital Signs & Physical Exam: T: 36.7°C (Oral) HR: 110(Monitored) RR: 18 BP: 159/90 SpO2: 99%

Physical exam is otherwise normal except for

Initial Diagnostic Testing:

  • CBC: normal except for
  • Chem 7: normal except for
  • Imaging: none

WHAT IS THE MOST LIKELY DIAGNOSIS?

  1. Thyrotoxicosis
  2. DKA
  3. Addison’s
  4. Hypocalcemia

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ANSWER:

 

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CASE CONCLUSION:    T3 501, T4 >30.0, TSH <0.01

OTHER ANSWERS:

  1. Never
  2. Always
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