Submitted by Dr LEUNG Yuk Wah Natalie, ICU, PYNEH, Hong Kong; on 14 December 2009
Figure. ECG of the patient (click Image to enlarge)
A 48-year-old lady with a history of total thyroidectomy for the “thyroid enlargement and thyrotoxicosis” in China 20 years ago. She was admitted to ICU due to generalized-tonic–convulsion (GTC). She had recurrent episodes of GTC attacks in recent 2 years, about 3-4 attacks per years. Besides, she also had tingling sensation over 4 limbs for 2 to 3 years. She was told to have hypocalcaemia by doctors in China about 3 months before this admission. Oral calcium and vitamin D supplements were given.
On the day of admission, she developed several minutes of GTC again, which was self-aborted before arrival to AED. She did not have head injury or fever before admission. On physical examination, the GCS was full and the power was normal. The reflex was normal. There was no definite sensation deficit elicited. Chvostek’s sign was negative. A 3cm firm neck mass, which moved with swallowing, was found in examination.
Figure. ECG
Figure. CT brain
What are the abnormalities in the ECG and CT brain?
What blood tests would you order?
What is your diagnosis?