Clinical Mysteries • Endocrinology
The Thyroid Patient With Chest Pain
The presentation
Palpitations, weight loss and tremor were followed by chest pain and rapid atrial fibrillation.
The first explanation was plausible, but the pattern did not fully fit. A deliberate second look focused on physiology, medication/exposure history, serial observations and the clue that the initial diagnosis could not explain.
The turn
The systemic clues connected the arrhythmia to endocrine disease.
Diagnosis
Thyrotoxicosis with cardiac involvement
Why this case matters
An arrhythmia can be the presentation of a systemic disorder.
Take-home message: When the clinical course contradicts the working diagnosis, stop escalating the same treatment and rebuild the problem from first principles.