A 61-year-old woman noticed that she often felt out of breath a few months earlier. She wondered if it was due to her weight, but her daughter suspected it could be a result of Covid infection she had a couple of years earlier. When her right leg started to hurt, she finally called her P.C.P.’s office. Her nurse practitioner suspected a clot in her leg that had broken off and lodged in her lungs, but there was no clot. During video consultations, her symptoms kept varying, and she was referred to a neurologist, a cardiologist, and Yale’s Long Covid Multidisciplinary Care Center.
POTS Diagnosis
At the center, it was suspected that the patient had POTS, a disorder that causes a rapid heart rate, or tachycardia, whenever patients stand up. It can be diagnosed using the active-stand test. However, the patient became lightheaded and out of breath after a few minutes, and her heart rate increased—prompting doctors to examine her thyroid gland. When they found out that her thyroid gland was flooded with hormones, indicating she had hyperthyroidism, she was quickly started on medication to manage the condition.
The Importance of Ruling Out
This case highlights the challenge of recognizing long Covid and its symptoms and demonstrates the importance of ruling out all possibilities before making a diagnosis. While there are no definitive tests that link present symptoms to a Covid infection experienced weeks, months, or years earlier, doctors should not make assumptions and should instead thoroughly examine a patient’s case before settling on a diagnosis.
Dr. Lisa Sanders, the medical director at Yale’s Long Covid Multidisciplinary Care Center, explains how frustrating it can be when doctors are unable to explain why a patient suddenly feels unwell in so many ways. As someone who has spent more than 20 years writing and thinking about diagnostic errors, she understands that diagnoses are mostly made by recognizing something that presents itself. Nonetheless, doctors should always rule out all other possibilities before making a diagnosis. In this case, medication helped the patient with her symptoms, but as Dr. Sanders reminds us, it’s essential to keep an open mind, and not to stop examining possible causes until every aspect of case has been thoroughly assessed.
Dr. Lisa Sanders is a celebrated medical writer and diagnostician, and her books include “Diagnosis: Solving the Most Baffling Medical Mysteries.” If you have an intriguing case to share, you can reach her at Lisa.Sandersmdnyt@gmail.com.
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