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Week 6: Clinical Case Study Part One Discussion
In this case, a 56-year-old female patient has complained of continuous tiredness for 2-3 months, as well as a 5-pound weight increase in the previous six months. Despite reporting 8 hours of sleep each night, the patient reports feeling unrested and lacking the stamina to carry out daily activities effectively. She works as a manager with physician and claims to have missed one day of work owing to severe tiredness around two weeks ago. Other clinical symptoms recorded that may be used to narrow down the differential diagnosis include constipation, widespread weakness, muscle cramping that occurs sporadically in the calves, cold sensitivity, and increasing sadness because of unproductive feeling. Among the physical examination findings which are relevant to diagnosis include: coarse hair, dry skin, and reduced BLE reflexes; the thyroid gland is thick and small; and a healthy thyroid. Her PMH includes high blood pressure, depression, and the fact that patient is postmenopausal. The allergies include colors, including iodine. Moreover, BP 146/95 Bisoprolo-HCTZ is the medication given for her. The patient denies having any sleep problems or sleeps apnea symptoms, which eliminates the possibility that this is the source of her primary complaint.
With all of the evidence I have collected, I have developed the following differential diagnosis, which I have listed in descending order from most probable to least likely.
Anemia
Depression
Hypothyroidism
Anemia
Our patient may have anemia, leading to fatigue and cold/hands and feet, but it does not explain both of these symptoms, including cold intolerance, constipation, etc. However, this is a possibility, and the symptoms patient is experiencing may be connected to any other issue.
Anemia develops because of a decrease in the formation of RBC, which transport oxygen to tissues, and a decrease in the function of this essential oxygen delivery mechanism. Many factors may cause anemia, and the most common are blood loss anemia, iron deficiency, and simple vitamin deficiency anemia (Smith, 2009).
Depression
Since the woman in question has a past of depression, but many of the signs and symptoms she is experiencing may be linked to depression, depression should be considered in this case. In addition to her tiredness and lack of energy, she is experiencing physical problems that are not explained. She is suffering from a depressed condition. Increased desires resulting from depression may also be a contributing factor to the patient’s increased weight. As a side effect of severe depression, patients may have numerous more unusual symptoms that seem inexplicable, such as palpitations owing to anxiety, which are often associated with the depression (Beck & Alford, 2009).
Hypothyroidism
Hypothyroidism is characterized by cold sensitivity, coarse hair, dry skin, tiredness, muscular pains, and the absence of deep tendon reflexes. The condition of hypothyroidism may also result in constipation and weight gain, which are all symptoms that our patient is now experiencing. The etiology of hypothyroidism may be attributed to various causes, including overtreatment of hyperthyroidism, autoimmune diseases, thyroidectomy, and radiation therapy, among other things. In addition, pregnancy, congenital abnormalities, pituitary dysfunction, and iodine shortage are all potential causes of hypothyroidism. Other variables to consider include several bodily systems, such as the cardiovascular system and the gastrointestinal tract, are affected by the pathophysiological mechanism of hypothyroidism, which is a complicated process with a wide variety of systemic consequences. In addition, reduced hormone production may be caused by problems with the pituitary brain and gland and the thyroid gland in general (Gaitonde, 2012).
I would include Hashimoto’s thyroiditis as well as hypothyroidism under the subcategory or differential of hypothyroidism. Hashimoto’s disease should also be considered a possibility for a diagnostic process since her signs are pretty similar to hypothyroidism; however, she did not have a goiter at the time of her presentation. Hashimoto’s may also be in the early stages, and this patient may not develop a typical goiter, depending on the circumstances. The differential diagnosis may be checked out with elementary laboratory testing. Hashimoto’s disease is an immune illness that affects the thyroid and results in hypothyroidism in certain people (Lorini, Gastaldi, Traggiai, & Perucchin, 2003).
Tests
I would request a complete blood count with differential to see whether an infectious disease results in an increase in WBCs and an RBC to rule out anemia if she has elevated WBCs. A BMP may also be performed to detect whether or not she has any electrolyte abnormalities or whether or not her renal system is dysfunctional. It is also recommended that she have a lipid panel done since she has a substantial family history of hyperlipidemia and because this is a side consequence of hypothyroidism. A TSH and T4 test is required to establish whether or not she is experiencing thyroid problems in the first place. A TPO-thyroperoxidase antibodies test (which would be a thyroid antibody screen) would also be performed to rule out Hashimoto’s disease as the reason for her hypothyroidism during this time. I would also consider having an ultrasound of her thyroid performed since there is such a strong indication that she may be suffering from hypothyroidism because her thyroid is tiny and solid in size. Finally, a PHQ-9, must be administered to assess the depression level.
References
Beck, A. T., & Alford, B. A. (2009). Depression: Causes and treatment. University of Pennsylvania Press.
Gaitonde, D. Y. (2012). Hypothyroidism: an update. South African Family Practice, 54(5), 384-390.
Lorini, R., Gastaldi, R., Traggiai, C., & Perucchin, P. P. (2003). Hashimoto’s thyroiditis. Pediatric endocrinology reviews: PER, 1, 205-11.
Smith, D. L. (2009). Anemia in the elderly. Iron disorders institute guide to anemia, 9, 96-103.
This the professor question that the writer needs to answer
Christelle,
What are the neurotransmitters in depression why is this important?
