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: allergies: haldol / sulfa (sulfonamide antibiotics) attending: chief complaint: rapid heart beat major surgical or invasive procedure: none history of present illness: 66 y.o woman medical history significant for asthma and paranoid schizophrenia who presented to the emergency room with right upper quadrant pain and was found to be in atrial fibrillation with an initial heartrate of 189. the patient reports that she had been feeling somewhat weak with nausea and subjective fevers over the past 10 days as well as having ruq pain over the past 3 days. she also reports some dyspnea on exertion at her baseline. in the emergency room, the patient received multiple iv pushes of diltiazem to a total of 50mg and was started on a diltiazem drip initially at 10mg/hr, then up to 20mg/hr with poor response and a rate continuing in the 150s. the patient then received metoprolol 10mg and developed bronchospasm with significant wheeze, after which she received 125mg of solumedrol and a single duoneb. cardiac enzymes were negative and imaging including a right upper quadrant ultrasound and chest x-ray were obtained. ruq was negative for cholecystitis and the cxr showed only a small left pleural effusion. . the ruq pain is not worsened by food, does not radiate, and is currently only a from a previously. . on review of systems, patient states she has a chronic productive cough of white/clear sputum and admits to myalgias especially left hip. she denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism, joint pains, hemoptysis, black stools or red stools. she denies exertional buttock or calf pain. she denies dysuria, hematuria, and increased urinary frequency. all of the other review of systems were negative. . cardiac review of systems is notable for absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. . in the ed, prior to transfer t: 99.7, hr 155, bp 118/77, rr 30, o2 saturation 97% on 2l, . past medical history: -smoking. -asthma/copd. -positive ppd. -schizoaffective disorder. -history of gi bleed. -history of hemoptysis. social history: lives at the ywca one block away from clinic by herself with two cats; (+)tob - hand-rolled cigarettes, cigs per day, (-)etoh now - h/o alcoholism, tried cocaine once but now (-)drugs. married twice - has not seen 2nd husband in several years. has 5 children. on disability." family history: no family history of early mi, arrhythmia, cardiomyopathies, or sudden cardiac death; otherwise non-contributory. physical exam: general: wdwn in nad. oriented x3. affect circumferential and tangential heent: ncat. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. neck: supple, no carotid bruits appreciated cardiac: pmi located in 5th intercostal space, midclavicular line. distant heart sounds, tachycardia with irregular rhythm. no m/r/g appreciated. lungs: no chest wall deformities, scoliosis or kyphosis. end expiratory wheezing throughout, crackles greater at the bases. abdomen: soft, ntnd. no hsm or tenderness. neuro: uvula midline, strength symmetric in upper and lower extremity, shoulder shrug intact to resistance, tongue midline. follows commands. extremities: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. pulses: right: carotid 2+ radial 2+ pt 2+; left: carotid 2+ radial 2+ pt 2+ pertinent results: admission labs: 11:25pm urine bnzodzpn-neg barbitrt-neg opiates-neg cocaine-neg amphetmn-neg mthdone-neg 04:20pm glucose-100 urea n-13 creat-0.5 sodium-140 potassium-3.5 chloride-104 total co2-25 anion gap-15 04:20pm alt(sgpt)-26 ast(sgot)-37 ld(ldh)-185 ck(cpk)-29 alk phos-121* tot bili-0.7 04:20pm ctropnt-< 0.01 04:20pm ck-mb-2 probnp-2173* 04:20pm asa-neg ethanol-neg acetmnphn-neg bnzodzpn-neg barbitrt-neg tricyclic-neg 04:20pm wbc-5.3 rbc-4.25 hgb-11.4* hct-33.6* mcv-79* mch-26.7* mchc-33.8 rdw-14.6 04:20pm pt-15.7* ptt-41.9* inr(pt)-1.4* . function tests: 04:20pm blood tsh-<0.02* 09:30am blood tsh-<0.02* 06:15am blood tsh-less than 06:38am blood tsh-<0.02* 06:52am blood tsh-<0.02* 09:15am blood tsh-<0.02* 06:08am blood t4-13.9* t3-250* calctbg-0.57* tuptake-1.75* t4index-24.3* 09:30am blood t4-11.3 t3-118 calctbg-0.67* tuptake-1.49* t4index-16.8* 06:15am blood t4-9.7 t3-77* calctbg-0.71* tuptake-1.41* t4index-13.7* 06:38am blood t4-8.3 t3-86 calctbg-0.85 tuptake-1.18 t4index-9.8 06:52am blood t4-7.5 t3-104 calctbg-0.88 tuptake-1.14 t4index-8.6 09:15am blood t4-7.8 t3-87 calctbg-0.91 tuptake-1.10 t4index-8.6 06:03am blood t4-7.1 t3-103 calctbg-1.00 tuptake-1.00 t4index-7.1 . test name in range out of range reference range --------- -------- ------------ --------------- tsi positive negative % thyrotropin-binding inhibitory immunoglobulin (tbii) test result reference range/units tbii 66.0 h <=16.0 % 06:15am blood antitpo-greater than assay . studies: cxr impression: left cp angle blunting could indicate small effusion or atelectasis. . ruq u/s impression: cholelithiasis without secondary findings to suggest acute cholecystitis. . cardiac echo: : the left atrium is mildly dilated. no atrial septal defect is seen by 2d or color doppler. the estimated right atrial pressure is 0-5 mmhg. left ventricular wall thickness, cavity size and regional/global systolic function are normal (lvef 75%). the estimated cardiac index is high (>4.0l/min/m2). there is no ventricular septal defect. right ventricular chamber size and free wall motion are normal. the aortic valve leaflets (3) appear structurally normal with good leaflet excursion. there is no valvular aortic stenosis. the increased transaortic velocity is likely related to high cardiac output. trace aortic regurgitation is seen. the mitral valve appears structurally normal with trivial mitral regurgitation. there is no mitral valve prolapse. there is mild pulmonary artery systolic hypertension. there is no pericardial effusion. . pathology report tissue: right lobethyroid, left study date of (pending) . discharge labs: 03:00pm blood wbc-7.2 rbc-4.80 hgb-12.6 hct-38.5 mcv-80* mch-26.2* mchc-32.7 rdw-17.9* plt ct-180 03:00pm blood pt-12.6 ptt-31.5 inr(pt)-1.1 07:25am blood t3-64* free t4-0.49* 11:15am blood digoxin-1.2 brief hospital course: 66 year old female with copd, asthma, paranoid schizophrenia who was found to have atrial fibrillation not responsive to rate control in the ed. . # atrial fibrillation: patient had asymptomatic afib in ed. it did not respond to iv diltiazem pushes or a maximal diltiazem drip. she was responsive to b-blocker but became brochospastic, likely as a result of underlying asthma and copd. she received nebulizers and steroids and her respiratory status subsequently improved. her rate was not controlled with diltiazem; she was transitioned to digoxin and verapamil in the ccu. rates ranged 130s-140s on this regimen. of note, the patient was not a candidate for cardioversion because she is not reliable for followup or taking medications; her chads2 score was 0 and so she was maintained only on aspirin. on , she spontaneously converted from afib to sinus rhythm with hr 80s. digoxin was held and verapamil was continued with plans to continue as an outpatient. she was subsequently transferred to the general medicine floor, where she remained in sinus rhythm for about 24 hours before periodically reverting back to afib with rvr to 170s, again asymptomatic. she did not respond to iv verapamil pushes, but tended to spontaneously convert within about 2 hours. her ccb was increased to 120mg tid, though she continued to convert between nsr and asymptomatic afib several times daily over the course of the following 6 days. cardiology was reconsulted , who recommended reloading of digoxin in addition to a transition to verapamil er 240bid. per daily physical exams, the patient remained in nsr for several weeks prior to thyroidectomy. she was discharged on verapamil and digoxin. these medications can likely be discontinued as an outpatient. . # hyperthyroidism: patient was found to be hyperthyroid on testing of tfts which is the presumed etiology of her presenting rvr. tfts were trended and patient was treated with sski +ptu in the ccu under the direction of endocrine. anti-tpo and tsi-ab were positive, suggesting a diagnosis of disease. sski and ptu were subsequently stopped and methimazole was started. her tft's normalized by . it was decided in conjunction with the endocrine and surgical teams that she would be better served by a thyroidectomy as opposed to a radioactive ablation. a meeting was held with the patient and her family, including her guaridan and son, who agreed with the plan for thyroidectomy. the thyroidectomy was performed by dr. without complication. post-op calcium level was 9.4. she was discharged on calcium supplementation. methimazole was discontinued post-thyroidectomy. she was not discharged on synthroid but will follow-up with endocrine who will initiate hormone replacement and titrate. . # copd: note that b-blocker is contraindicated in this patient copd. continued ipratropium bromide neb q6h + levalbuterol neb *nf* 0.63 mg/3 ml inhalation q6h. started prednisone 60 mg q day for a five day course, with last day . her steroids were restarted on due to considerable wheezing on exam. this was slowly tapered, and was eventually stopped on due to concern that it was driving some psychosis and agitation. she was started on advair and transitioned off of xoponex in favor of ipratropium to avoid excess adrenergic stimulation and exacerbation of her afib. for the last several weeks of her hospitalization the patient's copd was stable. she is discharged on her home inhalers. . # schizoaffective disorder: chronic problem; patient has stable paranoid delusions and poor insight into disease. initiated treatment with olanzapine 15 mg per psychiatry recommendations. per psychiatry, the patient has no capacity, cannot leave ama and as a result temporary guardianship for the hospitalization was awarded to her son . following resolution of her thyrotoxicosis, we asked the psychiatric team to reevaluate her in case her hyperthyroidism had contributed to her initial psychosis. she had attempted to leave ama shortly before psychiatric reevaluation, but was detected before leaving the floor. she was paranoid and agitated when seen by psych again, and was again deemed to have no decisional capacity. olanzapine was started. she initially required a 1:1 sitter, but eventually was happy to stay in the hospital and have her problem treated so the sitter was discontinued. . # abdominal pain on admission: non-specific. spontaneously resolved. ruq u/s showed no signs of cholecystitis. no leukocytosis. she was placed on pantoprazole given her history of a gi bleed, but this should likely be stopped as an outpatient. . # latent tuberculosis concern on admission: ppd placed right arm - ppd negative. . # health care proxy/guardianship: son awarded temporary guardianship ( . # code status: full medications on admission: ventolin atrovent discharge medications: 1. calcium carbonate 200 mg (500 mg) tablet, chewable sig: two (2) tablet, chewable po bid (2 times a day). disp:*120 tablet, chewable(s)* refills:*2* 2. aspirin 325 mg tablet sig: one (1) tablet po daily (daily). disp:*120 tablet(s)* refills:*2* 3. verapamil 240 mg tablet sustained release sig: one (1) tablet sustained release po q 12h (every 12 hours). disp:*60 tablet sustained release(s)* refills:*2* 4. fluticasone-salmeterol 250-50 mcg/dose disk with device sig: one (1) inhalation inhalation (2 times a day). disp:*1 disk* refills:*2* 5. digoxin 125 mcg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*2* 6. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po once a day. disp:*30 capsule, delayed release(e.c.)(s)* refills:*2* 7. olanzapine 5 mg tablet, rapid dissolve sig: three (3) tablet, rapid dissolve po bid (2 times a day). disp:*180 tablet, rapid dissolve(s)* refills:*2* 8. iron (ferrous sulfate) 325 mg (65 mg iron) tablet sig: one (1) tablet po once a day. disp:*30 tablet(s)* refills:*2* 9. ventolin hfa 90 mcg/actuation hfa aerosol inhaler sig: two (2) puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. disp:*1 inhaler* refills:*3* 10. oxycodone 5 mg tablet sig: one (1) tablet po q4h (every 4 hours) as needed for pain for 5 days. disp:*25 tablet(s)* refills:*0* 11. atrovent hfa 17 mcg/actuation hfa aerosol inhaler sig: one (1) puff inhalation twice a day. disp:*1 canister* refills:*2* discharge disposition: home with service facility: health systems discharge diagnosis: primary diagnoses: hyperthyroidism (likely grave's disease), thyroidectomy, atrial fibrillation secondary to thyrotoxicosis secondary diagnoses: paranoid schizophrenia, asthma discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: ms. , you were admitted to the hospital because you had a very rapid heart beat in an irregular rhythm. we tried to control this heart beat with multiple medications. one of these medications exacerbated your copd. we admitted you to the hospital to monitor and control your heart beat as well as to control your breathing. we found that you are hyperthyroid (meaning your is overactive) while you were here, and we started you on a medication to control this. likely, your high level is the reason that your heart was beating very quickly. you had a thyroidectomy to remove your . you tolerated the procedure well and your pain was well controlled at the time of discharge. you will need to follow-up with the doctors to replacement therapy, monitor your levels, and titrate your dose. . please make the following changes to your medications: you were started on digoxin. you were started on verapamil. you were started on calcium. you were started on omeprazole. you were started on iron. you were started on olanzapine. you were started on aspirin. you were started oxycodone for pain. . while you were here, your son, , was officially made your guardian. followup instructions: department: div of gi and endocrine when: tuesday at 2:40 pm with: , md building: ra (/ complex) campus: east best parking: main garage name: , n. location: health center address: , , phone: appointment: friday, at 11:15am **it is important that you go to the appointment above to continue your relationship with your primary care doctor** you should also call dr. (your surgeon) at to schedule an appointment for follow-up to be sure your incision is healing well. procedure: complete thyroidectomy percutaneous insertion of other extracranial artery stent(s) diagnoses: anemia, unspecified tobacco use disorder atrial fibrillation personal history of noncompliance with medical treatment, presenting hazards to health chronic obstructive asthma, unspecified legal circumstances paranoid type schizophrenia, chronic toxic diffuse goiter with mention of thyrotoxic crisis or storm 

Answer: The patient is high likely exposed to