An easily missed cause for low GCS in a Scottish Intensive Care Unit.

A case report of a 36-year-old patient who presented with seizures, a large thyroid and decreased consciousness level requiring admission to the intensive care unit, where the final diagnosis had a prevalence of 2.1/100,000 and a female to male ratio of 4:1. The final diagnosis was suggested early by a focussed internet search. This is unusual because as clinicians we often tell the general public to ignore an internet search. The early suggestion demonstrated that in the right hands the use of internet searches can help us make more informed decisions and aid patient management when combined with traditional investigative medical practice. However, the lesson with this case is that there are many unusual and rare causes of presentations to critical care units and as clinicians we should keep an open mind and wide differential diagnosis so as not to miss the rarer reasons for these presentations.