Question

1. Kate is a 30 year old woman who just delivered her second child two weeks ago. Two weeks after her delivery, Kate comes to your office to be evaluated. She states she has been tired, weak, and has widespread joint and muscle pain. Despite the mild weather, she notes that she is cold all the time, and that instead of losing her “baby weight” she has actually gained about 15 pounds.

   Kate has delivered two healthy children. She has no other medical history. It is her intention to breastfeed for at least the first 12 months. She continues to take her prenatal vitamins, and plans on having an intrauterine device placed for contraception at her six week follow up. She is a non-smoker, does not have a history of illicit drug use, and is currently abstaining from alcohol though she has consumed alcohol socially prior to her pregnancies.

   Her vital signs are as follows: Height 5’4”, weight 165 lb, Heart rate slowed at 48 beats per minute, blood pressure normal at 110/56, temperature normal at 98.2℉.

   • What disease process do you suspect is causing Kate’s symptoms? Name the disease and explain which symptoms, signs, or history information brought you to that conclusion.
   • What other symptoms do you suspect Kate may be experiencing? Are there any specific clinical signs you expect to find that have not yet been noted?
   • What type of laboratory workup would you expect for Kate?

Answer 1

1) The suspected disease is hypothyroidism.

Hypothyroidism is a disorder which is caused due to deficiency of thyroid hormones in the body.

The features favoring hypothyroidism as a clinical diagnosis due to following symptoms -

Slow heart rate ( 48bpm)

Cold sensitivity ( Kate is cold all the time )

Weight gain ( unexplained weight gain)

Tiredness and weakness ( lathargy)

Muscle pain and joint pain

Explaination- hypothyroidism results due to deficiency of thyroid hormones. Deficiency of thyroid hormones lead to decrease in body metabolic rate. The signs and symptoms of hythyroidism are - weight gain, fatigue, weakness, muscle ache, cold sensitivity, irritability, constipation, confusion, hair loss and dryness etc. Hypothyroidism is more prevalent in females than males.

2) Other clinical signs to be noted are -

Puffy face

Irregular menses

Impaired memory

Hoarseness of voice

Enlarged thyroid gland ( seen in goitre)

Joint swelling

Depression

Sluggishness

Sluggish reflexes

3) Laboratory investigations to confirm hypothyroidism include -

a)Blood TSH levels - increased in hypothyroidism.

b)Blood thyroid hormones (T3 and T4) - decreased.

c) Cholesterol levels - increased