Also known as: PAS-3
The patient, a marriage counselor, presents with syncope, fever, urinary incontinence, and double vision. Initially attributed to low testosterone from testicular trauma, his symptoms are ultimately diagnosed as PAS-3, an autoimmune condition that progressively attacks multiple endocrine glands including thyroid, gonads, and thymus.
Also known as: Low testosterone with testicular shrinkage
The patient's low testosterone was initially thought to be caused by testicular trauma from a bar fight three years ago, but is ultimately revealed to be part of PAS-3. The testosterone replacement therapy temporarily improves symptoms but causes behavioral changes including aggression and increased libido.
Also known as: Myasthenia
Part of the patient's PAS-3 presentation, causing diplopia (double vision), bladder atony leading to urinary incontinence, and eventual respiratory difficulties. The team treats with plasmapheresis before discovering the underlying autoimmune syndrome.
Also known as: Gluten intolerance
Another manifestation of PAS-3 affecting the patient's gastrointestinal system. His gluten-free diet had been masking symptoms, but reintroduction of gluten while hospitalized triggers liver problems and worsens his overall condition. Intestinal biopsy shows flattened villi.
The initial gland affected by PAS-3, occurring three years prior to current presentation. Manifested as chronic hoarseness in old videos of the patient's corporate coaching seminars, which has since resolved, representing the episodic nature of this thyroid condition.