Week 7: Discussion Prompt

Select one of the following discussion questions:

55-year-old female presents to your office with fatigue.  She states she has felt tired for many months and thinks “something is wrong” with her.  She denies any rectal bleeding, nausea, vomiting, abdominal pain. What else do you need to ask her about?

PMH- HTN controlled on lisinopril 20mg PO QD

Family Hx- No family history known as she is adopted

VSS and Physical Exam is WNL

Hgb- 10.9g/dL (13-18)

RBC- 3.53 m/mm3 (4.3-6)

MCV- 76 fL (78-100)

MCH- 24 pg (27-34)

RDW 19% (12.1-18.2)

Serum ferritin- 16 ng/mL (18-370)

Serum iron- 23 ug/dL (40-190)

TIBC- 391ug/dL (250-400)

Vitamin B12- 450pg/mL  (>200)

What is your Assessment and Plan? Please include specific instructions on any medication and education.

OR

A 42-year-old woman has noticed dry skin, fatigue, and weight gain over the past 3 months. Her blood pressure is 110/70 mm Hg, pulse 60/min, and heart and lungs are normal. Her skin feels rough and dry, but the rest of her examination is normal. Her biochemistry is normal, but the TSH is 39 mU/L. Provide at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

Expectations

Initial Post:

Due: Thursday, 11:59 pm PT

Length: A minimum of 250 words, not including references

Citations: At least one high-level scholarly reference in APA from within the last 5 years

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Week 7: Discussion Question – Heme or Endocrine

A 42-year-old woman has noticed dry skin, fatigue, and weight gain over the past 3 months. Her blood pressure is 110/70 mm Hg, pulse 60/min, and heart and lungs are normal. Her skin feels rough and dry, but the rest of her examination is normal. Her biochemistry is normal, but the TSH is 39 mU/L. provide at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

            Symptoms of Dry Skin, fatigue, and weight gain are strongly associated with Cognitive heart failure, depression, type 2 diabetes, and hypothyroidism. Normalcy in blood pressure and pulse rate rules out any cardiovascular condition.  The thyroid-stimulating hormone (TSH) blood test shows that there is a problem within the thyroid glands. Diseases associated with thyroid glands’ unusual functioning include hypothyroidism, Hashimoto’s thyroiditis, and Thyroid nodules (Hennessey, 2017). All these conditions are related to dry skin, fatigue, and weight gain. Since the woman is middle-aged, the chances of conducting Thyroid nodules are meager. Usually, Thyroid nodules do not show any signs. In this case, Hashimoto’s thyroiditis caused hypothyroidism in the 42-year-old woman.

           The woman needs thyroid supplements for the normal functioning of the glands. These dietary supplements include Iodine, selenium, iron, vitamin B12, copper, zinc, manganese, magnesium, and molybdenum (Akturk et al., 2018). The woman should use synthetic thyroid hormone levothyroxine to reverse hypothyroidism symptoms (Hennessey, 2017). Exercises such as cardiovascular training, Strength training, and Low-impact workouts should be recommended to build muscle and reduce susceptibility to cardiovascular conditions. Enough rest is also essential.

References

Akturk, H. K., Chindris, A. M., Hines, J. M., Singh, R. J., & Bernet, V. J. (2018, March). Over-the-counter “adrenal support” supplements contain thyroid and steroid-based adrenal hormones. In Mayo Clinic Proceedings (Vol. 93, No. 3, pp. 284-290). Elsevier.

Hennessey, J. V. (2017). The emergence of levothyroxine as a treatment for hypothyroidism. Endocrine55(1), 6-18.