Young women of menstruating age, those who have recently lost/donated blood, or who are actively bleeding, or those with a known history of chronic disease/autoimmune disease should be considered among this group. Should the constellation of patient symptoms suggest thyroid toxicity, such as diaphoresis, restlessness, palpitations, insomnia, weight loss, heat intolerance, etc, then testing for TSH and T3/T4 levels would also be appropriate. Finally, as the median BMI in the population continues to increase, one must also consider the obesity and deconditioning as a differential diagnosis, especially in patients who live sedentary lifestyles.
While not exhaustive, this overview gives a brief summary of conditions to consider in the setting of a family practice when patients present with complaints of shortness of breath or dyspnea. In summary, a system-based and patient-centred approach is imperative in making a relevant, high-yield differential. And as always, clinicians must keep in mind atypical disease presentations, as well as lower-yield diagnoses based on patient characteristics (chronic disease, environmental exposure, occupational history, travel history, etc.).