Draft

213  Mm Bl

213.1 Summary

  • 56M anesthesiologist (forced leave for MH)
  • Presented with BMI 20 -> 15 over 2 years
  • Paranoid but organized thinking, tremulous.
  • SOB -> ED. New LVEF 20% (from 50%). HR 130-140
  • TSH <0.01, T4 normal, T3 > 20 (max of assay). TRAB pending. No visible nodule/goiter.
  • “I take water buffalo thyroid”
  • “It’s not my heart [making me short of breath]. My heart is more like a conduit than a pump”
  • Denies thyrotoxicosis/thyroid storm is problem; declines to take methimazole/PTU. Refuses to see psych.

213.2 Slide outline

213.2.1 Slide 1

  • 56M anesthesiologist (forced leave for MH)
  • Presented with BMI 20 -> 15 over 2 years
  • Paranoid but organized thinking, tremulous.
  • SOB -> ED. New LVEF 20% (from 50%). HR 130-140
  • TSH <0.01, T4 normal, T3 > 20 (max of assay). TRAB pending. No visible nodule/goiter.
  • “I take water buffalo thyroid”
  • “It’s not my heart [making me short of breath]. My heart is more like a conduit than a pump”
  • Denies thyrotoxicosis/thyroid storm is problem; declines to take methimazole/PTU. Refuses to see psych.

213.3 Learning objectives

  • 56M anesthesiologist (forced leave for MH)
  • Presented with BMI 20 -> 15 over 2 years
  • Paranoid but organized thinking, tremulous.
  • SOB -> ED. New LVEF 20% (from 50%). HR 130-140
  • TSH <0.01, T4 normal, T3 > 20 (max of assay). TRAB pending. No visible nodule/goiter.

213.4 Bottom line / summary

  • 56M anesthesiologist (forced leave for MH)
  • Presented with BMI 20 -> 15 over 2 years
  • Paranoid but organized thinking, tremulous.
  • SOB -> ED. New LVEF 20% (from 50%). HR 130-140
  • TSH <0.01, T4 normal, T3 > 20 (max of assay). TRAB pending. No visible nodule/goiter.

213.5 Approach

  1. TODO: Outline the initial assessment or decision point.
  2. TODO: Outline the next diagnostic or management step.
  3. TODO: Outline follow-up or escalation criteria.

213.6 Red flags / when to escalate

  • TODO: List red flags that require urgent escalation.

213.7 Common pitfalls

  • TODO: Capture common errors or missed steps.

213.8 References

TODO: Add landmark references or guideline citations.

213.9 Slides and assets

213.10 Source materials