COPD, stroke and cocaine ...

A 53-year-old woman with a medical H/o COPD, stroke and cocaine abuse was presented with dizziness, shortness of breath and chest pain.

Her heart rate was 180 (onset of atrial fibrillation with rapid ventricular response), and she was given diltiazem 25 mg intravenously. Her urine drug screen was negative, and she had no recent history of upper respiratory symptoms.

A thyroid testing showed suppressed TSH, elevated T3 and free T4, consistent with hyperthyroidism. The patient had no thyromegaly, thyroid nodules or thyroid tenderness on palpation. Interestingly, she had evaluated blood thyroid function and an intravenous CT angiogram of the chest just two months before admission and was found to be normal.

She was temporarily prescribed oral propranolol since her hyperthyroidism was expected to resolve spontaneously.