Thyrotoxicosis presenting as Heart Failure
61 y/o Male who was treating a “fast HR” for years with Chinese herbals presents with history of increasing lower extremity edema and difficulty breathing. History significant for NYHA Class II/III symptoms and weight loss of 30lbs. Exam significant for cachexia, lid lag, pulmonary congestion, tachycardia, elevated JVP, possible pulsatile liver, pitting edema extending up to abdomen and cool extremities (wet/cool heart failure). Labs revealed hepatic dysfunction with elevated Bili and INR of 2 and Hyperthyroidism with TSH of 0.01.