Thyroid Disorders-Symptoms, Diagnosis, and Differential Analyses

 

 

Patient Information:

Initials: K.V.

Age: 44 years

Sex: Female

Race: Caucasian

S.

CC (chief complaint): Bulging eyes and fatigue

HPI: K.V. is a 44-year-old Caucasian female who presents with bulging eyes and fatigue for the past two weeks. She reports that she started experiencing bulging and painful eyes two weeks ago. She rated the pain five in a score of out of ten. K.V. highlights that she has been experiencing fatigue for the past two weeks despite having enough sleep and rest. The fatigue affects her, so she cannot carry out her daily activities. K.V. realized her neck was swollen that morning, so she visited the hospital. She is also experiencing unintended and uncontrolled weight gain, lowering her self-esteem. K.V. tries to take walks and exercise every evening to lose Weight, but she has continued to gain Weight. The weight gain is conspicuous since most of her clothes no longer fit her. Her plan to exercise is hindered by fatigue. She has not taken any medications to relieve her symptoms.

Current Medications:

Combined oral contraceptive pills O.D.

Paracetamol 1000mg TDS PRN

Allergies: No known food allergy. No known drug allergy.

PMH: K.V. is in good health. She experiences menstrual cramps every month during her menses, which she relieves using paracetamol 1000mg. She has been on combined oral contraceptive pills for the past five years. K.V.’s immunization is current; she received a single dose of Johnson and Johnson’s COVID-19 vaccine on 5/10/2022. She had a spontaneous vaginal delivery in 2003.

Soc Hx: K.V. is an accountant at a supermarket. She lives with her husband and son in a four-bedroom apartment. She is an occasional alcoholic drinker but does not smoke. She maintains a healthy life by eating a balanced diet and walking daily to and from work. She enjoys swimming and cooking new recipes. She lives a disciplined life and obeys traffic rules by always using a safety belt.

Fam Hx: K.V. has an 18-year-old asthmatic son. She is the last born of two children. Her elder brother is a known diabetic. K.V.’s mother died from breast cancer, while her father died from diabetes complications. Her paternal grandparents died of diabetes. Her maternal grandmother died of diabetes, while her maternal grandfather died of prostate cancer.

 ROS:

GENERAL:  Reports fatigue and weight gain. Denies chills, headaches, night sweats, day sweats, daytime sleepiness, sleep disturbances, or weight loss.

HEENT:  Reports bulging, painful eyes, blurred vision, decreased hearing, difficulty swallowing, and hoarse throat. Denies rhinorrhea, double vision, itchy eyes, visual loss, ear fullness, ear noises, ear discharge, and ear infection. Prohibits dry mouth, oral lesions, gum bleeding, or nasal congestion. Her last eye and dental examination were four years ago.

SKIN:  Denies rash or itching.

CARDIOVASCULAR: Denies lightheadedness when standing, paroxysmal nocturnal dyspnea, slow wound healing, numbness in extremities, palpitations, arrhythmias, dyspnea, chest pains, or orthopnea.

RESPIRATORY: Denies cough, wheezing, choking when swallowing, chest pains, shortness of breath, holding breath during sleep, difficulty breathing, or sputum production.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting, diarrhea, or abdominal pain.

GENITOURINARY:  Denies painful urination, urinary incontinence, dribbling, decreased stream, frequent urination, and blood in the urine. She denies pregnancy. She had her last menstrual period four months ago.

NEUROLOGICAL:  Reports changes in memory. Denies memory loss, loss of consciousness, seizures, confusion, difficulty balancing, numbness, tingling sensation, changes in thinking patterns, spells of blindness, or dizziness.

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding, or bruising.

LYMPHATICS:  Reports enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies a history of depression or anxiety.

ENDOCRINOLOGIC:  Reports cold intolerance. Denies reports of sweating, polyuria, or polydipsia.

ALLERGIES:  Denies history of asthma, hives, eczema, or rhinitis.

O.

Physical Exam:

Vital signs: BP 139/80 mmHg, HR-72 bpm, SPO2- 98% on room air, Temp 98.3, RR-18 bpm, Height- 163cm, Weight- 72kgs, BMI 27.1.

General:&