Hypothyroidism

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of ‍fatigueunintended weight gain

Symptoms include:

‍fatigue

‍increase in weight

‍dry skin

‍cold intolerance

‍constipation

‍depressed mood

‍hair loss

‍muscle aches

‍joint pain

‍menorrhagia

‍dry skin



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍pregnancy

‍postpartum period

‍iodine deficiency

no history of: ‍hypothyroidism, ‍thyroid surgery, ‍radiation treatment to the neck, ‍autoimmune disease

no use of: ‍levothyroxine, ‍liothyronine, ‍antidepressants, ‍lithium, ‍amiodarone

no family history of: ‍thyroid disease, ‍autoimmune disease





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal, cornea ‍intact, ‍PERRL, extraocular movements ‍intact, OD 20/‍, OS 20/‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍rashlesions on ‍

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

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Hypothyroidism ‍likelysuspectedpossible

DDx: Hashimoto's thyroiditis, hypothyroidism due to thyroidectomy, subclinical hypothyroidism, central hypothyroidism due to pituitary or hypothalamic disease, medication-induced hypothyroidism, thyroiditis, iodine deficiency, selenium deficiency, postpartum thyroiditis, silent thyroiditis, lithium-induced hypothyroidism, amiodarone-induced hypothyroidism, radiation-induced hypothyroidism, sarcoidosis, severe illness





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH, ‍free T4, ‍free T3, ‍thyroid antibodies

- Thyroid ultrasound

Treatments:

- ‍Levothyroxine

Further care:

- Repeat TSH in ‍ ‍weeksmonths

- Referral to endocrinologist

- Follow-up in ‍ ‍weeksmonths

- Return if symptoms worsen or if side effects develop