EACH PATIENT - AN OPEN BOOK Interesting Clinical Cases

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EACH PATIENT - AN OPEN
BOOKInteresting Clinical Cases

• Dr. R.V.S.N.Sarma., M.D., M.Sc., (Canada)
• 5 Jayanagar, Tiruvallur 602 001
• Mobile [phone]
• Visit us at www.drsarma.in

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Clinical Problem

• Middle aged lady
• Obesity
• Depression
• What was wrong ?
• How she was investigated ?
• What was the outcome ?

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Summary of the evaluations

• Clinical Presentation
• 48 year lady
• 80 kg weight
• Lack of interest
• Lethargic, Indolent
• MDD score high
• Clinically Hypothyroid

• Investigations
• TSH very high gt 100
• T3, T4 and FT4 very low
• LDL 171 mg
• TC 267 mg
• Eltroxin 50 300 mcg
• Atorvastatin 10 mg

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How is she today ?

• Follow up
• 49 year lady
• 61.9 kg weight
• Normal and active
• Anaemia improved
• No depression signs
• Clinically Euthyroid

• Investigations
• TSH ? (over corrected)
• FT4 and FT3 not done
• LDL 85 mg
• TC 168 mg
• HB 12 g
• ECG N HR 88/mt
• ? Eltroxin to 200 mcg
• Stop Atorvastatin

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What are the messages ?

• Hypothyroidism is an under current
• Unless suspected we will sure miss it
• Depression and hypothyroid are associated
• Pregnant / Middle aged women and
• Obese individuals need thyroid evaluation
• ? in LDL and TC may predispose for IHD
• Start low and Go slow, TSH for follow up