Differential Diagnosis for Profusely Sweating and Grating of Vision in a 47-year-old Female with Hypothyroidism

• Single most likely diagnosis:
  • Hyperthyroidism (despite known hypothyroidism, as some patients can have fluctuating thyroid levels or be on excessive thyroid replacement): This condition can cause sweating, anxiety, and possibly grating sensations due to muscle tension or tremors affecting the eyes.
• Other Likely diagnoses:
  • Anxiety or Panic Disorder: These conditions can cause profuse sweating and may be associated with visual disturbances or the sensation of grating vision due to heightened anxiety states.
  • Menopause: Given the patient's age, menopause could be a contributing factor, leading to hot flashes (sweating) and possibly affecting vision due to hormonal changes.
  • Medication Side Effects: Certain medications, including those for hypothyroidism, can cause sweating and visual disturbances as side effects.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodes of profuse sweating, hypertension, and visual disturbances due to catecholamine surges.
  • Thyrotoxic Crisis: A life-threatening complication of untreated or undertreated hyperthyroidism, which can present with extreme sweating, visual disturbances, and other systemic symptoms.
  • Neurological Disorders (e.g., Multiple Sclerosis, Optic Neuritis): Conditions that can affect vision and potentially cause systemic symptoms like sweating due to autonomic dysfunction.
• Rare diagnoses:
  • Autonomic Dysfunction: Conditions affecting the autonomic nervous system, which could lead to unusual sweating patterns and visual disturbances.
  • Mitochondrial Myopathies: Rare genetic disorders that can affect muscle and nerve function, potentially leading to unusual visual and systemic symptoms.
  • Certain Nutritional Deficiencies (e.g., Vitamin B12 deficiency): Though less common, severe deficiencies can lead to neurological and visual symptoms, including unusual sensations like grating vision.