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Rapid response to:

Practice Interactive case report

A 28 year old postpartum woman with right sided chest discomfort: case presentation

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7538.406 (Published 16 February 2006) Cite this as: BMJ 2006;332:406

Rapid Response:

Is this a thyroid issue?

If Mrs Patel's Hba1c is being monitored, so presumably is her TSH
(thyroid stimulating hormone), yet she is on a sub-physiological dose of
Levothyroxine. My immediate thought (long shot I grant you!) is papillary
carcinoma of the thyroid with lung metastases.

Investigations: chest x-ray, and scanning of chest and thyroid.

Start NSAID for pain and if my most tentative diagnosis is confirmed
high dose Levothyroxine.

I would explain that it is unusual for such a low dose of thyroid
replacement to work adequately which suggests "there might be something
else going on" - hence the need for further tests.

Competing interests:
None declared

Competing interests: No competing interests

20 February 2006
Stephen Head
General Practice Performer
Middleton Lodge, New Ollerton, Newark, Nottinghamshire, NG22 9SZ.