A 31-years-old housewife has been suffering from occasional loose motion

A 31-years-old housewife has been suffering from occasional loose motion, weight loss, weakness, palpitation and insomnia for 6 months.Three days before admission, she has been suffering from high grade, continuous fever, cough with yellow sputum, right sided chest pain, nausea and vomiting. On the 3rd day, she feels drowsiness, dizziness, followed by confusion, incoherent talk and delirium. On examination, looks very anxious and emaciated. Anemia-mild, few submandibular lymph nodes palpable, small smooth goiter is present, temperature – 40°C, BP – 160/70 mm Hg, pulse – 140/min, irregularly irregular Heart – systolic murmur in pulmonary area.
Investigations
• Full blood count - Hb – 10.5 gm/dl, WBC – 23,540/cmm,
poly – 88%, lympho – 12%,
platelets – 1,80,000/cmm,
ESR – 49 mm in 1st hr.
• Chest X-ray - Homogeneous opacity in the
left upper zone.
• ECG - Atrial fi brillation.
• RBS - 12.1 mmol/L.
• S. electrolytes - Sodium 128 mmol/L.
Potassium 4.1 mmol/L.
Bicarbonate 21.8 mmol/L.
Chloride 105 mmol/L.
• Urea - 45 mg/dl.
• Creatinine - 1.2 mg/dl.

Here the clue to diagnosis is goiter with loss of weight, loose motion, palpitation. Which are due to thyrotoxicosis hence the consolidation also got precipitated