Differential Diagnosis for Blurred Vision, Chest Pain, and Obesity

The patient presents with blurred vision at far distances, some pain in the left chest, obesity, and is taking levothyroxine 100 mcg for an implied thyroid condition, with a stressful job. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Hypothyroidism-related issues: Given the patient is on levothyroxine, inadequate thyroid hormone replacement or fluctuating levels could lead to symptoms such as blurred vision (due to dry eyes or Graves' ophthalmopathy if the underlying condition is autoimmune) and chest pain (possibly related to pericarditis or coronary artery disease risk increased in untreated or undertreated hypothyroidism). The stressful job could exacerbate symptoms.

• Other Likely Diagnoses

  • Refractive Error: Blurred vision at far distances could simply be due to myopia (nearsightedness), which is common and exacerbated by near work, especially in stressful jobs requiring prolonged screen time.
  • Dry Eye Syndrome: Common in individuals with thyroid disorders, dry eyes can cause blurred vision and are often seen in patients with autoimmune thyroiditis.
  • Anxiety or Stress-related Symptoms: The patient's stressful job could contribute to chest pain (anxiety-related) and possibly blurred vision (if stress leads to fatigue or exacerbates underlying conditions).
  • Obesity-related Conditions: Obesity increases the risk of several conditions that could cause chest pain, such as gastroesophageal reflux disease (GERD), and could exacerbate respiratory conditions leading to blurred vision due to lack of oxygen or increased pressure on the eyes.

• Do Not Miss Diagnoses

  • Myocardial Infarction (MI): Although less likely given the patient's age is not specified and the presence of other symptoms, chest pain must always prompt consideration of MI, especially in obese patients who may have increased risk factors for cardiovascular disease.
  • Pulmonary Embolism (PE): Obesity and possibly decreased mobility due to a stressful job could increase the risk of deep vein thrombosis and subsequent PE, which can cause chest pain and, in severe cases, lead to hypoxia causing blurred vision.
  • Diabetic Retinopathy: If the patient has undiagnosed or poorly controlled diabetes (which could be related to obesity), diabetic retinopathy could cause blurred vision.

• Rare Diagnoses

  • Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism, which could cause blurred vision, chest pain, and is exacerbated by stress.
  • Pituitary Tumor: Although rare, a tumor affecting the pituitary gland could lead to thyroid hormone imbalances, causing a variety of symptoms including blurred vision and could potentially cause chest pain if large enough to compress nearby structures.
  • Optic Neuritis: An inflammatory condition of the optic nerve that can cause blurred vision, more commonly associated with multiple sclerosis but could be seen in other conditions as well.