Differential Diagnosis
The patient's presentation is complex, with a wide range of symptoms that could point to various conditions. Here's a categorized differential diagnosis based on the provided information:
Single Most Likely Diagnosis
- Hyperthyroidism: This condition can explain many of the patient's symptoms, including tachycardia, hypertension, weight gain despite increased appetite, nausea, vomiting, fatigue, headaches, and possibly the hoarse voice. The high blood sugar and elevated leukocytes could also be related to hyperthyroidism, which can cause an increase in glucose production and a stress response leading to leukocytosis. The borderline long QTc interval on the EKG is also a known complication of hyperthyroidism.
Other Likely Diagnoses
- Anxiety Disorder or Panic Disorder: The symptoms of chest pain, shortness of breath, tachycardia, dizziness, and presyncope could be indicative of panic attacks, especially if there's a history of anxiety or stress. However, this wouldn't fully explain the laboratory findings.
- Gastroesophageal Reflux Disease (GERD): Could explain the sharp pain in the upper left quadrant (ULQ), nausea, and vomiting, especially if exacerbated by lying down or certain foods. The hoarse voice could be due to acid reflux affecting the vocal cords.
- Chronic Stress or Adrenal Insufficiency: Could lead to fatigue, weight gain, and possibly some of the gastrointestinal symptoms. However, the specific laboratory abnormalities would need further explanation.
- Polycythemia Vera: A myeloproliferative disorder that could explain the high platelet count, elevated leukocytes, and possibly some of the other symptoms like headaches and dizziness due to increased blood viscosity.
Do Not Miss Diagnoses
- Pulmonary Embolism (PE): Although the D-dimer is negative and there's no fever or UTI, a PE can sometimes present atypically, especially in younger patients. The symptoms of chest pain, shortness of breath, and tachycardia warrant consideration of this potentially life-threatening condition.
- Cardiac Conditions (e.g., Myocarditis, Pericarditis): Despite the negative troponin and normal chest X-ray, other cardiac conditions could still be present, especially given the EKG findings and symptoms like chest pain and shortness of breath.
- Pheochromocytoma: A rare tumor of the adrenal gland that could cause episodic hypertension, tachycardia, headaches, and sweating. Although less likely, it's a critical diagnosis not to miss due to its potential for severe complications.
Rare Diagnoses
- Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism, which could explain many of the patient's symptoms. It's rare but critical to recognize due to its high mortality rate if not promptly treated.
- Eosinophilic Gastroenteritis: A rare condition that could explain some of the gastrointestinal symptoms, though it would not account for all the patient's findings.
- Mastocytosis: A condition involving the accumulation of mast cells in various tissues, which could potentially explain a wide range of symptoms including gastrointestinal issues, headaches, and flushing, though it's quite rare and would require specific diagnostic testing.