Feeling Cold

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of feeling cold

Severity is ‍mildmoderatesevere

Pattern ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍fatigue

‍dry skin

‍hair loss

‍constipation

‍depression

‍menstrual irregularities

‍muscle cramps



Contributing factors:

‍low body weight

‍lack of physical activity

‍exposure to cold

‍alcohol use

no history of: ‍hypothyroidism, ‍anemia, ‍peripheral arterial disease, ‍diabetes, ‍Raynaud's phenomenon

no use of: ‍beta-blockers, ‍clonidine, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Functional cold intolerance ‍likelysuspectedpossible

DDx: functional cold intolerance, hypothyroidism, anemia, Raynaud's phenomenon, peripheral vascular disease, chronic fatigue syndrome, low body weight, poor nutrition, diabetes mellitus, hypopituitarism, adrenal insufficiency, fibromyalgia, beta-blockers side effect, neurological disorders, connective tissue diseases, chronic heart failure, COPD, deconditioning, environmental exposure, aging, blood vessel disorders





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍cortisol

Treatments:

- Warm clothing and blankets

- Regular exercise

- ‍Thyroid hormone replacement

Further care:

- Referral to endocrinologist

- Follow-up in ‍ ‍weeksmonths

- Return if feeling cold worsens or if new symptoms develop such as weight loss, fatigue, or fever