Background: In the US, thyroid stimulating hormone (TSH) is the 4th most commonly ordered laboratory test with thyroxine measurement being the 10th commonest. In 2016, Medicare alone spent $482 million on 21.5 million performed TSH tests and $12.28 million on 7.1 million performed thyroxine measurement tests. The objectives of this study were to analyze (a) [...]

Case Presentation: A 37-year-old-male with no significant past medical history who presents to the hospital with 2 months of progressive exertional dyspnea, palpitations and scrotal pain. He has also noticed some leg swelling and has a nonproductive cough. For the past 6 months, he has had ongoing diarrhea and unintentional weight loss of about 20 [...]

Case Presentation: A 28-year-old female with unremarkable past medical history presented with a 3-day history of fever, diffuse abdominal pain, nausea, and vomiting. Vital signs were significant for temperature of 38.3 C and heart rate of 180 BPM. Physical exam revealed left-sided costovertebral angle tenderness. Laboratory studies were notable for total bilirubin 2.7 mg/dL, direct [...]

Case Presentation: An 18 year old Asian man presented with sudden paralysis after a fall from a lofted bed during sleep. On arrival he reported inability to move his arms or legs. He denied any neck or back pain and did not experience any bowel or bladder incontinence. He reported no alcohol or drug use. [...]

Case Presentation: A 21-year-old previously healthy female with no known medical history was brought in by ambulance from a rave party with concerns for being pale, tremulous and diaphoretic. She reportedly had consumed three shots of alcohol, marijuana, and two unknown pills. On exam she was noted to be non-interactive, febrile to 104F, and with [...]

Case Presentation: A 66-year-old female with a history of primary hypothyroidism presented to the emergency department with an episode of vertigo. The patient reported a persistent spinning sensation, nausea, vomiting, and tinnitus of the left ear without hearing loss for over 10 hours. Review of systems revealed abnormal gait and findings consistent with hypothyroidism (cold [...]

Case Presentation: A 25-year-old man with no past medical history presented with five days of rapidly enlarging neck mass. He recently moved from India to San Antonio and noticed an unintentional weight loss of 20 pounds over the past month with a non-productive cough, nausea and vomiting. Denies neck pain, dysphagia and fever. Physical exam [...]

Case Presentation: 26 year old male with no history of substance use, only history of hypothyroidism status post radioactive Iodine treatment three years ago for Graves’ disease presented with three days of lower limbs pain, numbness and edema which impaired ambulation. He reported he had been doing a lot of walking at a convention when [...]

Case Presentation: 82 year-old female with a history of hypothyroidism on levothyroxine and coronary artery disease presented with 3 months of worsening generalized weakness, inability to walk, abdominal swelling, poor oral intake and 6 kg of unintentional weight loss. Review of symptoms was negative for fever, jaundice, orthopnea, dyspnea on exertion and syncope. Vital signs [...]

Case Presentation: 52-year-old male presented with six-week history of unintentional weight loss, decreased appetite and non-radiating dull suprapubic pain. Review of systems was notable for constipation, polyuria, polydipsia, nausea, and left leg swelling. No family history of cancer or blood dyscrasias. Physical examination revealed blood pressure- 194/114 mmHg, heart rate -105, distended abdomen with hypoactive [...]