Hypothyroidism
76 F complaining of fatigue and 30 lb weight gain over several mos.
Hx of hypertension controlled with hydrochlorothiazide 50 mg/d
BP 130/85 HR 52/min
History:
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What brings you in today?
 General
 Depression
 sadness
 inability to
concentrate
 hopelessness
 loss of sexual desire
 no interest in
activities
 Fatigue, tiredness
 Onset, duration
 Worse at end of day or in morning
 Worse after exercise, relief by rest
 Sleep habits
 Cold intolerance (Do you always feel cold?
Do you wear a sweater even in warm weather?)
 Voice changes (hoarseness?)
 Fever, chills, weight loss, sweating
 CVS
 Slow pulse
 Chest pains
 GI
 Anorexia
 Constipation
 Weight gain
 Poor appetite
 Neuro
 Memory loss
 Numbness or tingling
in the hands
 Slow speech
 Muscle cramps
 GU
 LMP, regularity, duration, fertility
 Derma
 Dry skin
 Hair falling out
Past Medical History
 Recent pregnancy
 History of radiation to neck
 Anemia
 Thyroid disease
 Infections
Medications
 Beta blockers
 Anti-histamine
Family History
 Thyroid disease
Social History
 Stresses at home or at work
 Exercise
 Abuse
 How has the tiredness affected
your life
 Past trauma
 Social support
Physical Examination
 Skin: texture, color, temp
 Facial expression, Size of tongue
 Thyroid gland
 Cardiac exam: rate, pericardial effusion
 Neuro
 DTR’s
 Parasthesia
 Slow speech
Questions:
1. Laboratory Tests:
 CBC, Electrolytes
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DDx:
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Total cholesterol
TSH, T4
ECG
Sedimentation rate
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Blood glucose
Serum creatinine
Total protein, albumin, globulin
Urinalysis
Serum Ca, PO4
Hypothyroidism
- Depression
Obesity
- Cushing’s Disease
Anasarca (due to cardiomyopathy, nephrotic syndrome, cirrhosis)
Chronic Disease (HIV, CHF, anemia, Ca, TB, CFS)
Medication
Enlarged Thyroid
40M presents with an enlarged thyroid
History:
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Symptoms of hyperthyroid
 General:
 Fatigue
 Heat intolerance
 Tremor
 Irritability
 CVS
 Palpitations
 GI
 Weight loss with increased appetite
 Frequency of bowel movements
 Thirst changes
 Neuro
 Proximal muscle weakness
 GU
 Scant menses
 Decreased fertility
 Derma
 Fine hair
 Moist warm skin
 Vitiligo
 Soft nails
 Family history of autoimmune problems
 Preceding UTI
Symptoms of hypothyroid
 See previous page
 Voice changes
 SOB
 Neck pain
Physical Exam
 Vitals
 tachycardia
 Head
 Hair
 Rashes
 Facial puffiness
 Lid retraction, proptosis, lid lag
 Eyebrow thinning
 sweating
 Nail changes
 Thyroid exam
 DTR’s