House S08EP3 “Charity Case”
In the next episode of House, a patient’s extremely generous donation and altruistic behavior might be a sign of an underlying medical disorder. House, of course, doesn’t believe that anyone does anything good just for the good of it (and he is right; see here from last spring), and is determined to get to the bottom of this case. And it looks like House is going with the all-girl diagnostic team this week, with Dr. Park (introduced last week), Dr. Adams (from the prison episode two weeks ago), and the guest appearance of my fave, Dr. Thirteen. Don’t read any further if you dislike SPOILERS!
I have to admit that I was having some trouble following things tonight, but as an excuse I will claim grading pressure as well as 12-year-old homework troubles as distractions. To recap: a rich man who likes to give his money away to charity collapses after giving a woman $1,000,000 for her ‘help the homeless get jobs’ placement service. Along the way House and his team suspect simple dehydration, Long QT syndrome (a congenital heart defect), Whipple’s Disease (an infection caused by the bacterium Tropheryma whipplei), Grave’s Disease (hyperthyroidism), until settling on another thyroid problem in Plummer’s Disease. In Plummer’s Disease, a nodule on the thyroid gland produces excess hormone, but not sufficiently high amounts to show up on a blood panel. In this case, the abnormal amounts of hormone were sufficient to cause some mental alterations in House’s patient. The condition was fortuitously diagnosed when the team gave an injection of iodine to increase contrast for an MRI imaging of the patient’s head, setting him into temporary thyrotoxicosis. The episode ends with House sending Thirteen away after firing her. The patient is cured by removal of the thyroid nodules, and no longer wants to give away all of his money.
This was a tough case, and I feel that the writers did not leave many clues for the diagnosis throughout the episode. The cognitive issues presented by the patient could potentially be caused by a huge number of things, and the other symptoms only showed up in a hit or miss manner. I was temporarily excited with the appearance of an infectious agent in Whipple’s Disease, but that diagnosis was quickly eliminated by the diagnostic work of Dr. Park. She was using the Polymerase Chain Reaction to try and demonstrate the presence of Tropheryma DNA in the patient samples. The analysis was extremely rapid, due to the type of equipment they were using, but came back with a negative result. An important point is demonstrated with this; that is, with many modern diagnostic techniques (serological and molecular-based) a negative result simply lets you know what is NOT wrong with the patient, and further diagnostics needs to essentially start from the beginning.