A Hidden Solution

A CLINICAL PROBLEM-SOLVING article by Pornpoj Pramyothin from Boston Medical Center and Boston University School of Medicine.
A 51-year-old woman presented to her local emergency room with a 6-month history of intermittent palpitations, which had worsened that day. She described her pulse as fast (it was approximately 140 beats per minute) but regular. She also reported recent worsening fatigue, heat intolerance, and an 18-kg (40-lb) weight loss despite a good appetite.
The patient had had a spinal cord injury at T12 from a car accident at the age of 21 years. The injury resulted in paraplegia with associated fecal and urinary incontinence, for which she underwent a colostomy and a urinary diversion with a Koch pouch (a continent ileal reservoir) that required self-catheterization several times daily.
On physical examination, her pulse was 99 beats per minute, and her blood pressure was normal. An electrocardiogram revealed sinus tachycardia. Ultrasonography of the thyroid gland showed that it was slightly enlarged but diffusely hypoechoic, findings suggestive of autoimmune thyroid disease. The iodine-123 uptake at 24 hours was 1.8% (normal range, 15 to 30).
The patient reported no ingestion of exogenous thyroid hormone, thyroid extract, or other dietary supplements that may have contained iodine. [Original Article]

Notes

• iodine [a'iəda`in]