History: A 65 year old housewife complains of progressive weight gain of 40 pounds in 1 year, fatigue, dizziness, sluggish memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.
Physical examination: Vital signs: temperature 96.4oF, pulse 68/minute and regular, BP 108/60, weight 170 lbs, height 5 feet, puffy face, pale, cool, dry skin. The thyroid gland is not palpable, deep tendon reflex time is delayed.
Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.4 ug/dl (N=4.5-12.5), the serum TSH is .9 uU/ml (N=0.2-3.5), and the serum cholesterol is 275 mg/dl (N<200).
- What is the likely diagnosis and what symptoms made you consider that diagnosis?
- Which lab data supported the diagnosis?
- Explain-Hypothalamic-Pituitary-Thyroid axis and interrelationship.
J.R. is a 58-year old man who presented with a 6-week history of polyuria, polydipsia, polyphagia, weight loss, fatigue, and blurred vision. A random glucose test performed on day of his visit and was 359 mg/dl. The patient denied any symptoms of numbness, tingling in hands or feet, dysuria, chest pain, cough or fevers. He had no prior history of diabetes and no family history of diabetes.
Admission non-fasting serum glucose 268 mg/dl (N=<180 mg/dl), HbA1c 9.6% (N=4-6.1%). Electrolytes, BUN and creatinine were normal. Physical examination revealed weight of 190 pounds, height 5’6.5″ . The rest of the examination was unremarkable, i.e., no signs of retinopathy or neuropathy.
- What are the mechanisms of blurred vision which was part of his initial symptoms?
- Are there correlations between his abnormal blood chemistries and his other symptoms?
- Identify the cardiovascular and microvascular risk factors in the history, physical examination, and laboratory data in this patient.
The likely diagnosis of the 65 years of a housewife who complains of a progressive weight gain of up to 40 pounds in a year is Huntington’s. This is an inherited health condition as affirmed by Caron, Wright, and Hayden (2018) that causes the killing of cells in a slow manner. This results in the deterioration in the cognitive ability of the patient and poor decision making. Other symptoms are seen in the initial time of the condition such as clumsiness and involuntary facial movements.
At a later date, the condition results in issues of patients having sudden risks of jerky and severe health problems that result from poor coordination. There is as well an increase in risks of the poor balance of the patient and problems in swallowing as well as risks of dementia. The risks of this health issue are that one will end up having risks of insomnia and fatigue or loss of energy with risks of social withdrawal from the others in the society….
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