Talk to General Physician on Extreme Pain In The Upper Back

Patient Summary : Female, approximately 53 years old, with diabetes and a known thyroid condition. She is currently not taking thyroid medication. She experiences recurrent pain in the upper back, often around the back or side of the shoulder, particularly after eating, and the pain is accompanied by sweating. The pain has been recurrent and has not resolved despite prior emergency visits and medications. Today, an ECG was performed and reported as normal. Troponin testing was not done. Someone recommended an echocardiogram, but it has not yet been performed. Thyroid tests show elevated TSH at 10.938 µIU/mL, with normal Free T3 and Free T4. Given her diabetes, recurrent postprandial shoulder or back pain with sweating, a cardiac cause still needs careful exclusion and further assessment, including troponin testing if indicated. Gallbladder disease including gallstones should also be considered because the pain often follows eating, and an abdominal ultrasound may be appropriate if cardiac causes are excluded. Elevated TSH requires separate thyroid management. Recommendation: please assess urgently whether troponin testing, repeat ECG, echocardiogram, and possible gallbladder ultrasound are needed, and advise on management. These are possible causes, not confirmed diagnoses. Please review previous prescriptions and reports.