41 year old man with weight loss and palpitations

• Medical history: Gilbert syndrome, depression. No known cardiac or pulmonary disease or history of cancer.


• Surgical history: Appendectomy in childhood.


• Medications: Sertraline. No dietary supplements or herbal products.


• Allergies: None.


• Family history: Father had a myocardial infarction at age 55 years and died of colon cancer at age 68 years. His grandmother had an underactive thyroid.


• Social history: The patient smokes 10 cigarettes per day, drinks 2 cups of coffee per day, and consumes alcohol only occasionally. He eats a healthy, balanced diet. No illicit drug use. He traveled to Spain more than 6 months ago. No known exposure to people with illness or infection. No sex partners besides his wife for many years. He works as an accountant in a company producing kitchen appliances.