18-03-2025
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.
DESCRIPTION
28y/M
k/c/o Hypothyroidism came for routine follow up
H/o easy fatigability + associated with body pains, not affecting daily life activities
H/o significant Hair loss (according to patient) diffuse, no patchy areas on scalp
H/o weight loss 3kgs in a month
H/o darkish discolouration + around the neck
no c/o constipation, abnormal weight gain, lethargy, palpitations
PAST HISTORY:
k/c/o hypothyroidism since his 12 years of age on medication Thyronorm 175mg
H/o constipation +
H/o haemorrhidectomy 2 years back
No other comorbidities
Trunkal obesity +
FAMILY HISTORY:
Father, (RMP by profession), died when the patient was of 4-5 yrs of age, due to unknown diabetic complication.
Mother, (housewife by occupation), died when the patient was an infant (he doesn't know any details about it)
Elder sister, died before he was born, details unknown about her mortality
Younger sister, died when the patient was about 1-2 yr old, details unknown about her mortality
ON PRESENTATION
pt is conscious, coherent,cooperative
Afebrile
Bp:110/70mmhg
PR: 70 bpm
RR: 16cpm
Spo2 :99% at room air
cvs: s1s2 heard, (loud S2, soft S1), no murmurs
Rs: BAE present, normal vesicular breath sounds, no added sounds
P/A: soft and non-tender
Cns : No focal neurological
deficit
No delayed reflexes
grbs : 108 mg/dl
[18-03-2025 19:32] PPM 1: 👆@PPM2 check out this patient's TFT inspite of being on 175 mcg
thyroxine since 12 years !!
@PPM3 please remove the images of his eyes as they may serve as identifiers. Also pm @CR the
signed informed consent form for her to create the case report.
[18-03-2025 19:33] PPM 3: Okay sir
[18-03-2025 19:34] PPM 1: @PPM3 tell us more about how he was diagnosed with hypothyroidism 12
years back and his hypothyroidism journey since last 12 years.
How frequently did he check his TFTs?
[18-03-2025 19:40] PPM 3: He was apparently shorter than his peers in school. So his father, being an
RMP, took him to a hospital in Hyderabad and got some investigations done as a general checkup.
Which incidentally led to him being diagnosed as hypothyroid.
[18-03-2025 19:41] PPM 3: He doesn't have the documents for previous checkups except for the recent
one being 4months ago, by an endocrinologist, sir.
[18-03-2025 19:44] PPM 1: He might remember if his TFTs were controlled since his age of 16 and at
what doses were they controlled then?
[18-03-2025 19:46] PPM 3: Before this endocrinologist checkup, he was on T. Thyronorm 100mcg sir
[18-03-2025 19:46] PPM 1: And we repeated our TFT here after how many days of 175 mcg?
[18-03-2025 19:47] PPM 3: Since 10/08/24 sir
[18-03-2025 19:47] PPM 3: 7 months sir
[19-03-2025 07:20] PPM 1: 👆@PPM2 your endocrine inputs needed here
[19-03-2025 16.33] PPM 1:
[19-03-2025 16:41] PPM 2: We need Free T4 and Free T3. How and when is the patient taking the
LTX?
[19-03-2025 16:41] PPM 2: Tbh I would check for Addisons in him.
[19-03-2025 16:43] PPM 2: When does he take his tablets and at what time?
[19-03-2025 16:49] PPM 1: 👆@PPM3
[19-03-2025 18.15] PPM 3: Till now, he was quite irregular with his medications sir. Sometimes he'd
take around 3-4am. Sometimes it's in the morning but he'd only wait for about 15-20mins and have his
breakfast, other times he'd forget to take his dose when travelling.
[19-03-2025 18:19] PPM 3: We asked him to wait for few more days for further evaluation, but he
apparently came unprepared and was willing to follow up with us later.
He's currently on his way home and was asked to review this Friday. But he told he couldn't this week,
but will come next Friday
[19-03-2025 19:55] PPM 1 Sir: Is he in this group?
[19-03-2025 19:56] PPM 3: Yes sir
[19-03-2025 20:01] : Let's say he's the patient's immediate advocate just so that he
can remain deidentified in all conversations
[19-03-2025 20:01] PPM 3: Okay sir
[19-03-2025 21:09] PPM 2: This very likely answers it.
[19-03-2025 21:10] PPM 1: What could be the reason for his childhood onset
hypothyroidism?
[19-03-2025 21:19] PPM 2: The likeliest reason would be Autoimmunity. Either Hashimoto or as part of
Autoimmune Polyglandular Syndrome.
[19-03-2025 21:20] PPM 2: Which is why I'd offer screening for cortisol deficiency. Both very closely
mimic each other.
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