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Week 6 Part 1 Case Study:
A 56 year old female patient reports constant fatigue for 2-3 months with a 5 pound weight gain in the last
six months. The patient reports sleeping approximately 8 hours at night but feels unrested with lack of
energy to perform daily tasks. She is an office manager in a physician office full time and reports missing
work one day 2 weeks ago due to extreme fatigue. Other reported clinical symptoms that could determine
a differential diagnosis include: constipation, generalized weakness, and muscle cramping intermittently
to calves, cold intolerance, as well as worsening depression due to feeling unproductive. Physical
assessment finding that are pertinent to clinical diagnosis includes: dry skin, thick coarse hair and
decreased deep tendon reflexes in BLE, thyroid is small and firm. Her PMH includes; HTN, Depression
and is postmenopausal. Her allergies include iodine dyes. BP 146/95 she is prescribed Bisoprolo-HCTZ
2.5mg/6.25mg. The patient denies sleep disorders and any complaints of sleep apnea which also rules out
the cause of her chief complaint.
With all the gathered information I have concluded the following differential diagnoses in order as most
likely to least likely.
1. Hypothyroidism
2. Anemia
3. Depression
Hypothyroidism
Hypothyroidism is characterized by cold intolerance, dry skin, coarse hair, muscle aches and fatigue as
well as deceased deep tendon reflexes. Hypothyroidism can also cause constipation and weight gain all of
which our patient is experiencing at this time. The cause of hypothyroidism can be due to many causative
factors including; over treatment of hyperthyroidism, autoimmune disorders, thyroidectomy, and radiation
therapy. Other factors that could cause hypothyroidism include pregnancy, congenital disorders, pituitary
dysfunction and iodine deficiency (Kalra, & Khandelwal, 2015).
The pathophysiological process of hypothyroidism is quite complex and has a wide arrange of systemic
effects of several body systems including the cardiovascular system and gastrointestinal tract for example.
The pituitary gland and hypothalamus as well as the dysfunction of the thyroid gland itself can cause
decreased hormone production (Janklaas, Bianco, Bauer, Burman, et. al, 2014).
Under the category or differential of hypothyroidism I would include Hasimotos as well. Hasimotos could
also be a consideration for a differential diagnosis due to her presented symptoms are very similar to
hypothyroidism, however she does not present with a goiter at this time. Hasimotos could also be in an
early stage and may or may not have a classic goiter on this presented patient. It would be a differential
that could be ruled out with simple lab work. Hasimotos is described as an autoimmune disorder that
affects the thyroid causing hypothyroidism (Caturegli & Remigis, 2014).
Anemia
Anemia can cause fatigue as well as cold/hands and feet for which our patient has fatigue but does not
explain her other symptoms such as cold intolerance, constipation etc. but could be considered for a
possibility at this point and the other signs and symptoms she is having could be related to other issues.
Anemia occurs due to lack of the production of red blood cells which carry oxygen to tissues, and lack of
this vital oxygen delivery system. Anemia can be caused by a multitude of problem with a small list of
being iron deficiency, blood loss anemia, and simply vitamin deficiency anemia (Stauder, Valent, &
Theurl, 2018).
This study source was downloaded by 100000832361371 from CourseHero.com on 02-03-2022 02:35:39 GMT -06:00
https://www.coursehero.com/file/30802216/week-6-part-1docx/
Week 6 Part 1 Case Study:
A 56 year old female patient reports constant fatigue for 2-3 months with a 5 pound weight gain in the last
six months. The patient reports sleeping approximately 8 hours at night but feels unrested with lack of
energy to perform daily tasks. She is an office manager in a physician office full time and reports missing
work one day 2 weeks ago due to extreme fatigue. Other reported clinical symptoms that could determine
a differential diagnosis include: constipation, generalized weakness, and muscle cramping intermittently
to calves, cold intolerance, as well as worsening depression due to feeling unproductive. Physical
assessment finding that are pertinent to clinical diagnosis includes: dry skin, thick coarse hair and
decreased deep tendon reflexes in BLE, thyroid is small and firm. Her PMH includes; HTN, Depression
and is postmenopausal. Her allergies include iodine dyes. BP 146/95 she is prescribed Bisoprolo-HCTZ
2.5mg/6.25mg. The patient denies sleep disorders and any complaints of sleep apnea which also rules out
the cause of her chief complaint.
With all the gathered information I have concluded the following differential diagnoses in order as most
likely to least likely.
1. Hypothyroidism
2. Anemia
3. Depression
Hypothyroidism
Hypothyroidism is characterized by cold intolerance, dry skin, coarse hair, muscle aches and fatigue as
well as deceased deep tendon reflexes. Hypothyroidism can also cause constipation and weight gain all of
which our patient is experiencing at this time. The cause of hypothyroidism can be due to many causative
factors including; over treatment of hyperthyroidism, autoimmune disorders, thyroidectomy, and radiation
therapy. Other factors that could cause hypothyroidism include pregnancy, congenital disorders, pituitary
dysfunction and iodine deficiency (Kalra, & Khandelwal, 2015).
The pathophysiological process of hypothyroidism is quite complex and has a wide arrange of systemic
effects of several body systems including the cardiovascular system and gastrointestinal tract for example.
The pituitary gland and hypothalamus as well as the dysfunction of the thyroid gland itself can cause
decreased hormone production (Janklaas, Bianco, Bauer, Burman, et. al, 2014).
Under the category or differential of hypothyroidism I would include Hasimotos as well. Hasimotos could
also be a consideration for a differential diagnosis due to her presented symptoms are very similar to
hypothyroidism, however she does not present with a goiter at this time. Hasimotos could also be in an
early stage and may or may not have a classic goiter on this presented patient. It would be a differential
that could be ruled out with simple lab work. Hasimotos is described as an autoimmune disorder that
affects the thyroid causing hypothyroidism (Caturegli & Remigis, 2014).
Anemia
Anemia can cause fatigue as well as cold/hands and feet for which our patient has fatigue but does not
explain her other symptoms such as cold intolerance, constipation etc. but could be considered for a
possibility at this point and the other signs and symptoms she is having could be related to other issues.
Anemia occurs due to lack of the production of red blood cells which carry oxygen to tissues, and lack of
this vital oxygen delivery system. Anemia can be caused by a multitude of problem with a small list of
being iron deficiency, blood loss anemia, and simply vitamin deficiency anemia (Stauder, Valent, &
Theurl, 2018).
This study source was downloaded by 100000832361371 from CourseHero.com on 02-03-2022 02:35:39 GMT -06:00
https://www.coursehero.com/file/30802216/week-6-part-1docx/
