History of present illness
T.H., a 30-year-old white female, is at her doctor’s office with the chief complaint being extreme fatigue. She has also noticed that she has gained some weight in the last few months. She contributes this to her inability to keep up with her normally routine workouts due to loss of energy and overall sleepiness even throughout the day. T.H. also has complaints of feeling cold all the time and problems with her eyesight. She also complains of difficulty swallowing and says her throat feels swollen. Her voice is a little hoarse, but she mentions she has gone to a concert a few days ago.
The doctor, who sees T.H. frequently, notices that T.H. who is generally upbeat and social seems depressed and has a hard time concentrating while questions are being asked. The doctor also notices the swelling in T.H.’s neck.
Past medical history
T.H. is an overall healthy individual. T.H. is slightly anemic. In the past two years, she has struggled with menstrual disturbances and has had one miscarriage 6 months ago.
Pertinent family history
T.H.’s mother has type 2 diabetes, which she has a hard time controlling. She also struggled with miscarriages (2) at childbearing age. T.H.’s father has hypertension.
Pertinent social history
T.H. does not smoke and does not drink alcohol. She is married and lives with her husband. They have been trying to conceive for the last two years and are having difficulty.
Allergies
NKA- No known allergies
Medications
Since T.H. is slightly anemic, she takes 65mg of iron daily. She also takes a daily vitamin.
Focused physical exam
T.H. is seen to have dry skin and brittle hair upon further physical assessment and shows some weakness in the extremities. The doctor palpates the thyroid gland and finds that it is enlarged so she wants to send the patient to further testing.
She is sent to an endocrinologist and an MRI is done. An enlarged pituitary gland is found. The tumor is benign, but this shows that the thyroid gland is at fault and is not producing enough hormones, making the pituitary gland work harder. Hence the problems with the eyesight and all of the other symptoms she has.
Also found is a goiter. She is subsequently diagnosed with hypothyroidism, which is the most common form of Hashimoto’s thyroiditis.
Lab Values
TSH testing (mU/L—milliunits per liter)
0.4: normal, 2.5: at risk, 4.0: mild hypothyroidism, 10.0: hypothyroidism.
T.H. results = 9
Free T4 testing (micrograms per deciliter)
5 to 13.5: normal
T.H. results = 2
Anti-thyroid Antibodies testing
Presently unknown; T.H. will need to be sent to a specialist for further testing and lab work.
Reference
Hypothyroidism: Practice Essentials. (1994-2015) Medscape. http://emedicine.medscape.com/article/122393-overview