Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: history of present illness: this is a -year-old female, with a history of atrial fibrillation, hypertension, atrial tachycardia, hypothyroidism, status post ddd pacer placement in after being admitted for palpitations and syncope, and a question of calcium channel induced bradycardia. of note, the patient's cardiologist is dr. . the patient's thyroid supplementation was decreased from 75 to 50 mcg po qd after she was observed to have several runs of atrial tachycardia. the patient now presents with progressive weakness. the patient lives alone, walks with a cane. over the past several days, she has been unable to get out of bed, poor po intake. the patient denies any change in appetite. per the family, the patient leans to the right with walking, but there is no feeling of presyncope. there have not been any falls since the pacer was placed. the patient also reports nonproductive cough x three days. the family states that the patient has been more confused with worsening in her short and long-term memory. she has generally had more trouble taking care of herself. it seems like changes of confusion and memory have taken place over the last several months. review of systems: the patient complains of right-sided headache consistent with her trigeminal neuralgia, history of diplopia but no current diplopia, no dysphagia, shortness of breath, chest pain, abdominal pain, nausea, vomiting, fevers, chills, gu symptoms, diarrhea or constipation, lower extremity pain, or swelling. she states she has a decent appetite, sometimes feels cold. no known weight change. in the ed, and add on to labs from revealed a tsh of 25. the patient's prior tsh back in was 4.7. past medical history: 1) hypertension, 2) atrial fibrillation, 3) atrial tachycardia, 4) status post ddd pacer placement in , 5) history of left hip fracture, 6) trigeminal neuralgia, 7) hypothyroidism, 8) squamous cell carcinoma, 9) history of polio affecting the left leg. medications: 1) aspirin 81 mg po qd, 2) levothyroxine 50 mcg po qd, 3) toprol xl 12.5 mg o qd, 4) digoxin 0.625 mg po qd. allergies: penicillin. social history: the patient lives alone. no alcohol or tobacco history. physical exam: temperature 97.1, blood pressure 160/90, pulse 72, respirations 20, o2 sat 96% on room air. in general, the patient is in no apparent distress. heent - mucous membranes moist, perrla, eomi, oropharynx clear. neck supple, no jvd. lungs clear to auscultation and percussion bilaterally. cardiovascular - regular rate and rhythm, no murmurs, gallops, or rubs. abdomen soft, nontender, nondistended, normoactive bowel sounds. extremities - no clubbing, cyanosis or edema. neuro - the patient is oriented to hospital, but not month or year. the patient has normal attention but poor short-term memory per mini-mental status. cranial nerves ii through xii intact. upper exam is notable for symmetric and normal strength and sensation. biceps - dtrs are 2+ bilaterally. lower extremity exam is limited by inability to relax. gait is normal. labs: white count 9.5 with 59% neutrophils, 32% lymphocytes, hematocrit 44.5, platelets 382. sodium 138, potassium 4.6, chloride 101, bicarb 25, bun 17, creatinine 1.1, glucose 105, inr 1.0. digoxin level from was 0.4. tsh level from was 25, up from 4.7 on . urinalysis showed a specific gravity of 1.006, otherwise normal. studies: left hip film showed no fracture or dislocation. there is a left femoral screw in place. chest x-ray - a questionable left lower lobe atelectasis. echocardiogram from showed an ef of greater than 75%, normal right ventricular size and free wall motion, moderate mr, mild pulmonary artery hypertension. ekg - normal sinus rhythm at 70 beats per minute, normal axis, atrially paced, no st or t wave changes, no q waves, unchanged. hospital course: in short, this is a -year-old female, with a history of hypertension, atrial fibrillation, atrial tachycardia, status post ddd pacer placement in , hypothyroidism, who now presents with failure to thrive including decreased energy, confusion, worsened memory, poor po intake, inability to complete adl. 1) failure to thrive: of note, the patient's labs were notable with greatly elevated tsh. on recheck, the patient's tsh had declined to 40. interestingly, her free t4 level was on the lower end of normal being 0.6. the patient did report feeling cold, although there has been no clear appetite change or weight change. the patient's elevated tsh and low-normal free t4 may account for her symptoms. the patient was restarted on her original dose of levothyroxine of 75 mcg po qd. this is going to likely take several weeks to attain therapeutic level. other sources of failure to thrive were considered. the patient did not seem to be dehydrated by either her physical exam, her labs, or her urinalysis. in terms of her heart, the patient was atrially paced at 70 beats per minute. the pacer appeared to be working well. in terms of infectious sources, the patient never had any fever or white blood cell count. the patient's chest x-ray was normal, as well as her urinalysis. there were no other new medications that could explain these changes. the patient had a b12, folate, rpr, all of which were normal. finally, it is possible that the patient has some progressive dementia, likely alzheimer's or body, as it seems that her confusion and memory lapses may have preceded the change in the thyroid medication. 2) cardiovascular: as already noted, the patient has not complained of any palpitations or presyncope. the pacemaker appears to be working well. the patient was continued on aspirin, toprol and digoxin. given the increase in her dose of levothyroxine, the patient will need to be monitored closely for atrial tachyarrhythmias. 3) activity: the patient was evaluated by physical therapy. they recommended a stay at a skilled nursing facility, even though the patient appears to be walking well on her own. occupational therapy has also been consulted. 4) code: i spoke to the patient's family and the patient. they had not addressed her code status. at this point, the patient and her family are discussing the code status. code is full for now. 5) disposition: at this point, due to the patient's general confusion and weakness, she is unable to complete her basic adl. she will require at least a two to three week stay at a rehab facility while her thyroid function normalizes and her functional status can be better assessed. given a gradual decline in cognitive status prior to her recent worsening, family was considering permanent placement. condition at discharge: good. discharge medications: 1) aspirin 81 mg po qd, 2) levothyroxine 75 mcg po qd, 3) toprol xl 12.5 mg po qd, 4) digoxin 0.0625 mg po qd. discharge instructions: 1) the patient will need to follow-up with her pcp within one to two weeks. 2) she will also need to have her tsh and free t4 rechecked in two weeks to assess for progress. if these has normalized and the patient continues to have symptoms of confusion, low energy, memory loss, she will likely need to be worked-up for a dementia. 3) the patient is also to follow-up with her cardiologist, dr. , within one month's time. discharge diagnoses: 1) hypothyroidism with subtherapeutic thyroid supplementation. 2) failure to thrive. 3) hypertension. 4) atrial arrhythmias, status post pacer placement. 5) dementia. , m.d. dictated by: medquist36 procedure: injection or infusion of thrombolytic agent diagnoses: unspecified essential hypertension unspecified acquired hypothyroidism atrial fibrillation other persistent mental disorders due to conditions classified elsewhere cardiac pacemaker in situ cerebral embolism with cerebral infarction adult failure to thrive 

Answer: The patient is high likely exposed to