A repeated measurement 2 years later (now year 2013) showed a lower, yet still ‘normal’ (ie, within reference range), value of 360 nmol/L. During assessment by the endocrinologist, problems with upset stomach and general arthralgia were noted and it was even then morning serum cortisol was measured for the first time, resulting in a normal value of 680 nmol/L. Already then, the patient met criteria for moderate depression, which had not been helped by psychologist contact. Thereafter, a concerned general practitioner referred the patient to an endocrinologist for assessment of long-standing and disabling problems with excessive sweating, accompanied by a tendency towards social isolation. The patient was diagnosed with hypothyroidism approximately 10 years ago, and at least initially complied with levothyroxine therapy. Medical history of interest: In his adolescence, the patient underwent treatment with isotretinoin because of severe acne. Postural dizziness and fatigue have bound him to the sofa, and he has slowly been deteriorating as features of social isolation, lack of concern and extreme exhaustion have become more and more prevailing. A 33-year-old young man alerts an ambulance because of weakness of such a severe degree that intake of food and medications has been insufficient for some time.
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