In the New York Times, Lisa Sanders regularly presents diagnostic puzzles and dilemmas. The current one (spoiler alert) turns out, at the end, to be hyperthyroidism. However, the actual patient had seen tons of health care professionals and had tons of tests before the diagnosis was made.
I gave ChatGPT3.5 - the free version - the 1200 words of the case, ending before the correct test and solution were found. ChatGPT immediately processed the case and explained that humans would discover the missing diagnosis to be hyperthyroidism.
Here is the case. I fed it the text up to here: .....This was a middle-aged woman who had a racing heart, who became short of breath with any exertion, who was rapidly losing weight — a classic presentation of [WHAT DISEASE?].
Here is the GPT response:
"Based on the provided information, a possible diagnosis that was missed for this patient could be hyperthyroidism. Hyperthyroidism is a condition in which the thyroid gland produces an excessive amount of thyroid hormone, leading to an overactive metabolism. The symptoms mentioned in the case study, including a racing heart, shortness of breath, and rapid weight loss, are common manifestations of hyperthyroidism. However, it is important to note that without further medical evaluation and diagnostic tests, it is not possible to provide a definitive diagnosis. Other potential diagnoses could also be considered based on the patient's symptoms and additional information."
Hyperthyroidism is correct. Can you discuss why it took the human health professionals so long and so many tests to solve the case in the same way that you did?
Certainly! There are a few reasons why the diagnosis of hyperthyroidism might have been missed initially and why it took several tests and consultations to reach a conclusion:
Non-specific symptoms: The symptoms presented by the patient, such as a racing heart, shortness of breath, and weight loss, can be seen in various medical conditions. These symptoms are not specific to hyperthyroidism alone, making it challenging to pinpoint the exact cause without further investigation.
Overlapping symptoms with other conditions: Hyperthyroidism shares symptoms with several other disorders, including anxiety, cardiac conditions, and even long-term effects of previous COVID-19 infection (as suspected in this case). This overlap can make it difficult to differentiate between different potential causes.
Complex nature of the human body: The human body is intricate, and symptoms can often be multifactorial or have overlapping causes. It's not uncommon for patients to have multiple underlying conditions or for symptoms to have multiple contributing factors. This complexity can sometimes make it challenging to identify the primary cause of a patient's symptoms.
Sequential approach to diagnosis: In the case of this patient, the healthcare professionals followed a sequential approach to diagnosis, ruling out potential causes one by one. They conducted various tests, including ultrasounds, X-rays, an echocardiogram, a Holter monitor, and even an MRI and CT scan. This method aims to eliminate potential causes systematically, but it can be time-consuming, especially when dealing with non-specific symptoms.
Unpredictability of long COVID: The patient's previous COVID-19 infection and the emerging concept of long COVID further complicated the diagnostic process. Long COVID is still not fully understood, and the wide range of symptoms associated with it makes it challenging to attribute specific symptoms solely to the previous infection.
In summary, the complexity of the human body, the overlapping nature of symptoms, and the need to rule out various potential causes can contribute to delays and multiple tests before reaching a conclusive diagnosis. The diagnostic process often requires thorough investigation, considering all possible explanations to ensure an accurate diagnosis and appropriate treatment.\
In a hypothetical, if hyperthyroidism had proved to NOT be the cause, what would you have thought about next?
If hyperthyroidism was ruled out as the cause of the patient's symptoms, and further evaluation was needed, the following considerations could be made:
Adrenal gland disorders: Dysfunction of the adrenal glands, such as adrenal insufficiency or adrenal hormone overproduction (e.g., Cushing's syndrome), can present with symptoms such as fatigue, weight loss, dizziness, and cardiovascular manifestations. Testing for adrenal function, such as cortisol level measurements, may be warranted.
Cardiac conditions: Despite ruling out hyperthyroidism, there could still be cardiac disorders contributing to the symptoms. Further evaluation of the heart, such as assessing for arrhythmias, heart failure, or valvular abnormalities, may be necessary with additional cardiac tests and consultations with a cardiologist.
Pulmonary conditions: If the shortness of breath remains unexplained, it is important to consider respiratory disorders such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, or pulmonary hypertension. Pulmonary function tests, imaging studies, and a consultation with a pulmonologist might be required.
Autoimmune disorders: Certain autoimmune conditions, like systemic lupus erythematosus (SLE) or rheumatoid arthritis, can have diverse symptoms and may be worth considering. Additional autoimmune markers and consultations with a rheumatologist might be needed.
Gastrointestinal disorders: Unexplained weight loss can be associated with gastrointestinal conditions such as malabsorption syndromes, inflammatory bowel disease (IBD), or malignancies. Further evaluation with gastrointestinal endoscopy, imaging studies, and specialized blood tests may be warranted.
Infectious or chronic inflammatory conditions: Certain infections, such as tuberculosis or chronic viral infections, as well as chronic inflammatory conditions like sarcoidosis or vasculitis, can manifest with various symptoms. Specific tests for infectious agents or inflammatory markers might be required.
Endocrine disorders: While hyperthyroidism has been ruled out, other endocrine disorders like pheochromocytoma (a tumor of the adrenal glands), parathyroid disorders, or pituitary gland abnormalities could be considered. Appropriate hormone level measurements and consultations with endocrinologists might be necessary.
The specific diagnostic approach would depend on the patient's complete medical history, physical examination findings, and any additional symptoms or abnormalities identified during the evaluation process. Medical professionals would tailor the diagnostic workup based on the individual patient's presentation to identify the underlying cause of the symptoms.