Discussion Topic----Rubric Attached
BCASE STUDY: Fatigue, Constipation, and Weight Gain
Reason for Seeking Care
A 40-year-old woman is seen for primary care by the clinician. The woman is a patient who is well known to the practice. She complains of fatigue, constipation, and weight gain that is unintentional and unable to be controlled with the diet. The woman is seeking advice for her condition. The woman has been steadily gaining weight over several months and the clinician recognizes that the woman is gaining considerable weight.
History of Present Illness and Health History
The patient reports weight gain of 30 pounds over 6 months. The woman indicates she has tried to maintain her usual activities of hiking, biking, and outdoor gardening; however, she feels fatigued and finds it difficult to maintain her usual activities. The woman also indicates she has been developing constipation but thinks it may be due to “getting older.” She now uses a fiber supplement daily to prevent constipation. The woman has a history of using birth control pills to manage heavy menstrual bleeding, but otherwise is healthy. She now has an IUD for birth control and to manage the heavy bleeding that has been present for more than 2 years. She has three children and had a total of four pregnancies, one of which resulted in miscarriage. The youngest child is 6 years old.
Physical Examination
- General: Well-nourished, woman who appears age stated. The woman is overweight, now weighing 210 pounds or 95.2 kg.
- Head: Wears contact lenses or glasses, admits hair has been falling out and appearing thinner when questioned. Denies other vision or hearing problems. No significant change in diet over last 6 months except adding fiber supplement.
- Neck: No masses, thyroid smooth and symmetrical.
- CV: Heart rate and rhythm regular, no murmur. Peripheral pulses are equally palpable in all four extremities. Heart rate 65, blood pressure 130/90.
- Lungs: Breath sounds equal bilaterally, clear to auscultation.
- Abdomen: No hepatomegaly, abdomen slightly rounded, indicates problems with constipation, managed with fiber supplement.
- Neuro: Denies changes in mood or memory, gait is steady. Is oriented to person, place, time, and situation.
- Skin: No rashes or wounds. Skin smooth and dry. Patient indicates her nails are brittle and hair has been “falling out” more than usual and appears somewhat thin.
- GU: Patient denies any problems with urination or problems related to IUD.
1. The clinician considers hypothyroidism as a possible diagnosis for this patient. What lab values should the clinician order?
2. Why is the clinician less concerned about thyroid cancer in this patient?
3. The patient has no indication of iodine deficiency and the TSH level is elevated. What is the likely cause of this patient’s hypothyroidism?
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