65F Thyroid swelling 20 years Telangana PaJR

 

29-05-2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS

[3:14 PM, 5/29/2026] PPM 1: Slowly progressive goitre @PPM3 @PPM4  do you remember how many months or years?

Attached imaging and pathology

[3:15 PM, 5/29/2026] PPM 4: Yes sir

[3:15 PM, 5/29/2026] PPM 4: Since 20 years sir

[3:15 PM, 5/29/2026] PPM 4: Colloid cyst sir

[3:15 PM, 5/29/2026] PPM 1: Also has a left caries tooth with left temporal referred pain

Also agreeable to an excision biopsy of the thyroid

[3:16 PM, 5/29/2026] PPM 4: Planned for ultrasound Guided aspiration sir

[3:21 PM, 5/29/2026] PPM 1: Therapeutic aspiration?

An excision biopsy would be more cosmetically as well as histopathologically satisfying?

[3:22 PM, 5/29/2026] PPM 1: @PPM4 @PPM3 what's the thyroid function tests results in this patient although she's clinically euthyroid

[3:22 PM, 5/29/2026] PPM 4: Ok sir, Will have a word with Patho mam sir

[3:25 PM, 5/29/2026] PPM 1: 👆@PPM4 recall her TFTs? I'm assuming they are normal

[3:27 PM, 5/29/2026] PPM 4: Normal thyroid function sir

[3.39 pm, 29/05/2026] PPM 1: Any reports image available?

76M Urinary dribbling thin stream 1 yr pain and hematuria Diabetes 1 mth CKD 1mth Uttar Pradesh PaJR

 

29-05-2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED PROBLEMS  AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[9.44 am, 29/05/2026] PPM 1: First history from OPD

Gen medicine history from IP day 1

  
                                                                                                          General surgery handwritten history

                                                                Progress notes

                                      

Vitals intake output and food plates. Have planned for his four point sugar profile

                               

                                                                   Investigations
                                         

  

                                        

[12.59 pm, 29/05/2026] PPM 1: Finally we also managed to capture the image of his obstructive kidneys but looking at the obstruction perhaps his azotemia may not be explained by post renal obstructive uropathy alone rather there's some renal component too which makes this case more challenging.

34F Hypothyroid 1 month Telangana PaJR

 THISIS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[9:57 AM, 5/28/2026] PPM 1: Because of a spike in PaJR onboarding, the local doctors in the PaJR platform appear to be finding it difficult to keep track of who these patients are! 

Real patient anonymity finally? @PPM2 @PPM3 @PPM4 

One solution to this is to gather all the data in the OPD before we get them to sign consent but again in a busy OPD this may not be feasible for the local doctors unless we have an assistant specifically dedicated to this task. We have tried that earlier by training a human pool geared toward task shifting but that has it's own limitations although again the current stance is likely to be a judicious mixture of both!

@PPM5 @PPM6 do you recall this patient from OPD? Can we get some more telephonic history of the initial events and subsequent course from her here @CR?

[12:15 PM, 5/28/2026] CR: The patient was having indigestion, weakness, leg cramps (pulling down) and is feeling as if her heart is going downwards (don't know the medical term). All these symptoms are there since 1 month. She is feeling her pulse fluctuations also.

She is a homemaker with twin boys and a girl. She has regular and normal monthly periods.

After consultation at our hospital she was prescribed 88mcg Thyronorm since 1 week. Asked them to share the reports. This little info gathered from her husband.

[12:18 PM, 5/28/2026] PPM 1: Very well taken history 👏👏

Was she absolutely alright one month back?

What was her daily hourly routine then?

What happened to her daily hourly routine after she developed her symptoms since one month

[12:20 PM, 5/28/2026] CR: Will let you know soon as he is on duty and mobile with him.

[6:34 PM, 5/28/2026] CR: The patient was normal before and started feeling weak and restless. Has problem of cramps in her legs. 

Earlier she was able to do her daily chores well, but now she is feeling lethargic and not feeling to do, but somehow managing.

Asked her to share her daily activities and food plates regularly.

[7:32 PM, 5/28/2026] PPM 1: @PPM6 @PPM5 do you recognise the handwriting here?

@CR please check if that bar code scan shows any hospital identifiers. Also can the patient elaborate on the history of her shortness of breath as mentioned in the handwritten note?

[7:35 PM, 5/28/2026] PPM 1: 👆@PPM2 this is getting to be a very commonly ordered test? Does it really help in addition to change any management once in the presence of actionable TFTs?

[7:39 PM, 5/28/2026] PPM 1: Can they also share her lateral view of arms and abdomen?

[7:45 PM, 5/28/2026] CR: At present there is no shortness of breath. She is fine. Main problems are cramps and weakness. Asked them to share her lateral view of arms and abdomen.

[8:19 PM, 5/28/2026] PPM 2: Unlikely to be of any use. Although does help with Hashimoto and rule out a Viral thyroiditis / post partum (can occur upto 1 year later) thyroiditis if so.

[8:22 PM, 5/28/2026] PPM 5: This was written by me sir but I don’t remember the exact history of the patient

[9:59 PM, 5/28/2026] PPM 4: If the patient is on thyroxine but still has cramps + weakness, possibilities include:

     · Under-replaced hypothyroidism (persistent myopathy)

     · Over-replaced / iatrogenic hyperthyroidism (thyrotoxic periodic paralysis or thyrotoxic myopathy)

     · Poor adherence or malabsorption

[10:00 PM, 5/28/2026] PPM 4: One more possibility: spurious or counterfeit thyroxine

50M Hypertension with Target organ changes Telangana PaJR

 

27-05-2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[4:43 pm, 27/05/2026] PPM 1: @PPM3

Share the target organ changes noticed in this patient

[4:54 pm, 27/05/2026] PPM 3: Kidney- reduced Gfr 

Heart- pedal edema (indicates rt heart failure)

Para sternal heave (rt ventricular enlargement) 

Ecg changes- left axis deviation 

Saemens sign (indicates left ventricular hypertrophy) sir

35M Hypothyroid yrs left shoulder pain recent Repetitive Stress Injury Telangana PaJR

 

26-05-2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[8:39 pm, 26/05/2026] PPM 1: @PPM3 do you recall his morning history of hypothyroidism how he was started on 150 mcg some years ago for a TSH of 300 and then didn't check his TFTs for a year and later someone found his TSH to be 36 and brought down his dose to 75 mcg and today his TSH was 9 @PPM4?

[8:58 pm, 26/05/2026] PPM 3: Yes sir

[8:59 pm, 26/05/2026] PPM 3: Today TSH was 9

[9:09 pm, 26/05/2026] PPM 1: On examination for his chest and arm pain it appeared to be a rotator cuff injury with extreme tenderness during internal and external rotation.

Need to check physiotherapy support videos for the above

[9:25 pm, 26/05/2026] PPM 3: Ok sir

14F Pubertal adenomatous goitre Telangana PaJR

 

27/05/2026

THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HER GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY EXPERTS WITH AN AIM TO SOLVE THOSE PATIENT'S CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUTS.

[2.51 pm, 27/05/2026] PPM 1: Cosmetic goitre

@PPM3 do you remember since when?

Free T3 raised

Others normal

Anti TPO and TSH receptor antibodies negative

Usg, fnac attached

                               
[2:55 pm, 27/05/2026] PPM 2: Free T3 is classically raised in Thyroid Nodules which isn't Graves