38 year old female with hypothyroidism
This is the case of a 38-year-old female, teacher, and resident of West Bengal, who was interviewed through a telephone conversation. A thorough history was taken which is as follows.
Chief complaints :
- Joint Pains since 7 years
- Constipation since 5 years
- Pain abdomen since 15 days
HOPI :
The patient was apparently asymptomatic 7 years ago.
7 years ago, the patient started having arthralgia. The pain was dull in character, present at one joint at a time including the - knee and shoulder joints bilaterally. The pain was continuous, present even at rest, aggravated by movement, and relieved by taking painkillers. The patient suggests that she still experiences this pain. One significant episode from two years ago includes, persistent pain in her right shoulder, which was dull in character, intermittent, increased on working, relieved on rest. IT reduced her ability to work as it made her uncomfortable. She visited a doctor who prescribed paracip for 6 days, which reduced her pain.
5 years ago, the patient was also facing menstrual irregularities. The duration of the menstrual cycle was delayed every month, ranging from 30 to 45 days. Initially, this was associated with oligomenorrhea followed by menorrhagia.
Menstrual cramps are present in the lower abdominal region, thighs and lower back. This pain is of dull character and intermittent. It begins 6 days before the onset of the period and lasts till the second day of the period. This pain is still present.
The patient also had difficulty conceiving after which she consulted a doctor, where a thyroid profile test was done, on the basis of which the patient was diagnosed with hypothyroidism and was started on levothyroxine. The patient does not recollect the initial dose but suggests that the dose has changed every few months, and the current dose consumed is 100 mcg of levothyroxine.
In addition to these symptoms, the patient also experienced weight gain inspite of decreased appetite, Which has now reduced from 80 kgs to 68 kgs over 5 years after starting levothyroxine. At the moment she is expressing a reduced appetite.
5 years ago, the patient had constipation which is still present. The stool is hard, absence of blood and mucous, bloating and tenesmus. It is not alternating with diarrhoea.
The patient also complained of tiredness, and examples of which she explained by her includes: initially her school (place of work) was 70 km far from her house, this journey did not tire her, but 5 years ago, she had a transfer of to 3 km from h house. The commute used to tire her.
Other symptoms still present include increased hair fall and dry unmanageable hair.
There is no dry skin, difficulty in concentration or poor memory, dyspnoea, hoarse voice, paraesthesia, or impaired hearing.
15 days ago, the patient described a sudden onset of abdomen pain , which was dull in character, continuous, and lasted for 1 day. The patient frequently experiences such episodes since, sometimes, the pain is present near the epigastrium and bilateral hypochondrium regions while at other times it is present in the lower half of the abdomen.
The pain was associated with a fever of 101 degrees Celsius, which was relieved by self-medication of Calpol 600 mg 3 times a day. Other associated symptoms include cough, and sore thoat , which are still present with reduced severity.
The patient also complained of tiredness, and examples of which she explained by her includes: initially her school (place of work) was 70 km far from her house, this journey did not tire her, but 5 years ago, she had a transfer of to 3 km from h house. The commute used to tire her.
Other symptoms still present include increased hair fall and dry unmanageable hair.
There is no dry skin, difficulty in concentration or poor memory, dyspnoea, hoarse voice, paraesthesia, or impaired hearing.
15 days ago, the patient described a sudden onset of abdomen pain , which was dull in character, continuous, and lasted for 1 day. The patient frequently experiences such episodes since, sometimes, the pain is present near the epigastrium and bilateral hypochondrium regions while at other times it is present in the lower half of the abdomen.
The pain was associated with a fever of 101 degrees Celsius, which was relieved by self-medication of Calpol 600 mg 3 times a day. Other associated symptoms include cough, and sore thoat , which are still present with reduced severity.
Treatment history
- Thyronorm 100 mcg every morning before breakfast.
Known case of hypothyroidism since 5 years
The patient is not a known case of TB, HTN, Epilepsy, Asthma, or Heart Disease.
No history of surgeries or blood transfusion.
Personal History
Diet - Mixed
Appetite-Reduced
The patient is not a known case of TB, HTN, Epilepsy, Asthma, or Heart Disease.
No history of surgeries or blood transfusion.
Personal History
Diet - Mixed
Appetite-Reduced
Sleep - Adequate in quantity and quality.
Addictions: The patient consumes tambaku and gud for 3-4 years, about 4 times a day
Bowel movements - constipation
Bowel movements - constipation
CLINICAL IMAGES
Investigations :
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