Question

A new patient visits your office with several complaints that seem to have been increasingly problematic over the past several weeks. The patient says that she fears that she is very ill; for she has gained 5 pounds in the past month, has had difficulty getting out of bed in the morning, and has been experiencing terrible headaches. The patient asserts that her energy level throughout the day is low, that she has not been able to enjoy her usual activities for the past several weeks, and she feels anxious every time she leaves her home. She states that she believes that after doing online research, that she has a thyroid problem, and notes that there is a history of thyroid problems in her family. Her vital signs are within normal limits, and other than the aforementioned weight gain, there is nothing remarkable noted in her physical examination. However, as the physical is being performed, she does seem to be a bit confused. The patient also asks for a prescription to treat her headache. A) What other data, both subjective and objective might be important to gather in order to effectively diagnose this patient’s condition? B) What other laboratory tests would you request for this patient, and why?

Answer 1

A) What other data, both subjective and objective might be important to gather in order to effectively diagnose this patient’s condition?

Collect subjective data like compaints of constipation, cold intolerence, joint and muscle pain, extreme weakness after any activity, forgetfulness etc. These are some of the clinical manifestations of Hypothyroidism. Ask about her urine output, water inatke etc to aid in the diagnosis of weight gain. Ask data about her food pattern, meal choices etc since she is gaining weight. Ask about any losses in life, how she spend his pleasure time, family support system available, anxiety level etc, Which helps in the diagnosis of anxiety and depression. In anxiety and depression also there will be weight gain, decresed activity, not experiencing happiness etc are seen.

In objective data, assess for her hair pattern, frequent loss of hair,thin hair, cool and calmy skin etc. Which may indicate hypothyroidism. Assess for any body edema. Calculate the patients BMI based up on height and weight. Assess for pale conjunctiva for identifying anemia. Monitor her vital signs.

B) What other laboratory tests would you request for this patient, and why?

Thyroid function test : Thyroid function test is a blood test conducted to indentify the functioning level of thyroid gland. this test provide informations about TSH level, T3 level and T4 level in blood, with which the diagnosis of thyroid function can be identified. In most of the clinical conditions, the symptoms of Hypothyroidism or Thyroid abnormality may go unnoticed, without showing much symptoms. Hence this test can be conducted to identify the thyroid gland functioning.

Complete Blood count (CBC): This is an another blood test carried out to identfy the blood parameters. This will provide information about cell parameters, their count etc. RBC, WBC other blood cells etc included in this studyAlong with alterations in the results, the diagnosis of any infection, decresed oxygen carrying capacity of the RBC etc can be diagnosed.

Hemoglobin Analysis: Another useful blood investigation which helps to identify chronic anemia condition. As per the subjective data of the patient, she is having complaints of weight gain, fatigue, decreaed activity etc, All these symptoms can be because of a chronic anemia. So hemoglobin analysis will helps in the diagnosis of anemia.

Electrolyte studies: Deficiency or excess of certain electrolytes lik sodium, potassium etc can cause some of the clinical manifestations like head ache, weight gain etc. So a detailed electrolyte studies can be conducted.

Calcium & vitamin D monitoring: This will provide information about the calcium and vitamin D concentration in blood, also provide information about how effectively thyroid gland is functiong to control calcium in the body. Decresed calcium and vitamin D may indicate osteoporosis.

Endocrine Function Monitoring: Some of the endocrine disease like cushing syndrome may also have the same clinical manifestations that the patient is expecting. hormonal imbalances in the body can be diagnosed with endocrine function monitoring.