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.
@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
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