Course 19, Case 8
Revision 2010
Kas 19-8E: Tachycardia, weight loss, heat intolerance
Present History
34-year-old woman was admitted to the hospital because of tachycardia. She does not feel
well for a couple of months. She complains on heat intolerance and sweating. She gets readily
tired, she can hardly concentrate. She observes accelerated hair-loss. She complains on
diarrhea and weight-loss of 7 kg in the last year. She often feels the palpitations and
occasionally the heart-rate reaching 120/min. The symptoms are more intensive in the last
days and that’s why she visited her GP.
Personal history:
Followed by the endocrinologist 10 years ago for a disease of thyroid gland. She was doing
well and that’s why she stopped the regular visits and the medications.
Family history: nonremarkable
Examination:
BP 120/55 mmHg, PR 118/min, BT 36,7°C.
Sweaty, thin-bodied.
Thin hair, exophtalmus.
Goiter, discrete murmur.
Heart sounds regular, discrete systolic murmur on aortal valve.
Laboratory findings:
Normal laboratory findings except of: low TSH 0.002, hyperglycemia 20 and ketonuria.
Chest X-ray: normal
ECG: sinus tachycardia, otherwise normal curve.
Questions:
1. What type of disease could cause these symptoms and findings, what are
pathophysiologic mechanisms?
2. Characterise organ specific and organ nonspecific autoimmune diseases
3. What are mechanisms and risk for autoimmune diseases development
4. What further examination and tests would you propose, do you suspect other
immunopathology disease to develop, why?
5. What other symptoms patient could have?
6. Pa – disorders of termoregulation
7. PP - thyroid hyperfunction