Assignment task: A 53 yr old woman presents to her primary care provider with complaints of fatigue, weight gain, and constipation. She states that her weight has gradually increased over the last year despite no change in her activity level or eating habits. She works roughly 8 hours a day as a nutrition assistant but she falls asleep as soon as she gets home in the afternoon. Upon questioning, the patient reports the following changes: thinking of her scalp, hair, brittle nails, dry skin and cold intolerance.
Additional HX: no pertinent medical hx, NKDA, currently not taking any meds, LMP 3 years ago, Mom has an autoimmune disorder, she is unsure which one.
Physical examination:Alert and orientated x3, T 37 C orally, P 59 and regular, RR 14, BP 120/60
Skin: hair is course, dry and thinning; nails are brittle; skin on extremities appear flakey and dry
labs: TSH 3.4lU/L (normal range is 0.4-3.0ml/U/L)
Free T4 0.4ng/dl (normal range is 0.8 -1.8ng/dl)
Analyze the information presented to assess, diagnose, and manage the above patient.
1. What are the signs and symptoms associated with the disease process?
2. What diagnostic should be performed?
3. Have you clearly defined the patient's problem?
4. What are the things you would do to determine the diagnosis?
5. What you need to consider when choosing the medications?
6. What diagnosis should be treated aggressively?
7. Which drug to start?
8. Recommend follow up