Mrs. Davis Comes To The Office Today With Complaints ✓ Solved

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Mrs. Davis comes to the office today with complaints of recent

Mrs. Davis comes to the office today with complaints of recent unexplained weight loss. She reports that her weight loss has been sudden and severe with a loss of fifty pounds in three months. She also reports consistent diarrhea that is yellow and liquid. Along with these symptoms, she was prompted to make an appointment due to increasing fatigue, eventually impacting her daily life.

At this point, my differential diagnosis was Irritable bowel syndrome, Inflammatory Bowel Disease, Diarrhea, Malabsorption Syndrome, Dumping Syndrome, and Malnutrition (Pimentel, 2016). When performing the health interview she reported alopecia, along with increasing fatigue. At this point, I had believed that it strengthened my differential diagnosis as a decrease in inadequate absorption would show signs of malabsorption or a gastrointestinal issue (Pimentel, 2016). However, continuing the health interview, the patient also reported that she had her parathyroid glands removed but did not know why. Upon finding out this information I also wanted to check her thyroid gland before ruling out thyroid involvement.

Upon the physical exam, the patient was noted to have "visible thyroid fullness and diffuse enlargement on palpation" which is a key indicator that the thyroid gland is overworking due to an unknown origin (Pandiyan et al., 2018). At this point, my entire differential has changed to Hyperthyroidism, Diarrhea, Malnutrition, Irritable Bowel Syndrome, and Inflammatory Bowel Disease (Pandiyan et al., 2018). I decided to investigate this further during the lab portion of the exam, and the results showed a T4 of 22.8 and TSH of 0.01. An elevated T4 and a suppressed TSH are indicative of hyperthyroidism, even with unknown etiology (Pandiyan et al., 2018). Upon combining the subjective and objective data I felt confident that this was the diagnosis.

On a side note, the patient did mention that she was vegan, so even though she was experiencing hyperthyroidism, there was a possibility that her weight loss could have also had other contributing factors such as a poor nutritional diet (Pandiyan et al., 2018). In vegan diets, it is a common occurrence that there is a lack of appropriate nutrition even if eating the appropriate amount of calories per day (Menzel et al., 2020). However, this is easily overcome with better nutritional discipline and eating the right combination of foods that provide a total day's worth of nutrients (Menzel et al., 2020). I wanted to explore her diet more and assess the appropriateness of the diet but the program is limited.

For the plan, I wanted to involve endocrinology as the patient has had previous endocrine-based surgeries in the past. So a referral would be made to endocrinology for further exploration and additional management of the disease process (Pandiyan et al., 2020). I could also start her on Methimazole 15mg oral daily to begin management of the disease but would defer to endocrine for any additional changes (Pandiyan et al., 2020). I would also like to see her in a month to evaluate the treatment and plan of care for this patient.

Paper For Above Instructions

Mrs. Davis, a patient presenting with a significant unexplained weight loss of 50 pounds over a span of three months, alongside symptoms such as diarrhea, fatigue, and alopecia, showcases a complex clinical picture that necessitates a thorough diagnostic evaluation. Initial differential diagnoses should prioritize conditions that commonly associate with weight loss and gastrointestinal disturbances, such as Malabsorption Syndrome, Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD), hyperthyroidism, and the possibility of malignancy. The combination of the subjective report of significant weight loss and objective findings from a physical examination, notably the enlargement of the thyroid, provides critical insights into her health status.

The change in focus to hyperthyroidism is supported by both physical examination findings and laboratory results. A T4 level of 22.8, paired with a TSH of 0.01, strongly indicates an overactive thyroid as per established endocrinological standards (Pandiyan et al., 2018). Hyperthyroidism can lead to weight loss through mechanisms such as increased metabolic rate and altered gastrointestinal function.

Moreover, the patient's history of parathyroid surgery invites scrutiny of her calcium metabolism and thyroid regulation, highlighting the importance of understanding the endocrine system's interconnected dynamics (Pandiyan et al., 2020). It is essential to delve into the detailed history surrounding her surgery as it may provide crucial information regarding possible endocrine disorders that could complicate her current situation.

In managing Mrs. Davis's case, the established plan should be multifaceted. Referral to endocrinology is paramount owing to the potential complexities arising from her previous surgeries and the necessity for specialized management of hyperthyroidism. In conjunction with a referral, commencing treatment with Methimazole, an antithyroid medication, would be prudent to control her thyroid hormone levels until an endocrinologist can further evaluate her (Pandiyan et al., 2020). It would also be beneficial to schedule follow-up appointments to monitor her response to therapy and any dietary modifications she may need, especially considering her vegan diet.

Dietary evaluation and modification should also be a priority given the potential impact of her nutritional choices on both her thyroid function and overall well-being (Menzel et al., 2020). Awareness of the nutritional gaps often present in vegan dietary patterns can lead to tailored dietary advice, ensuring that Mrs. Davis meets her nutrient requirements while managing hyperthyroidism.

In conclusion, an integrative approach involving thorough diagnostic evaluation, interdisciplinary collaboration, and ongoing patient education is crucial for addressing the complexities of Mrs. Davis's health challenges. The nexus of her symptoms, coupled with endocrine implications and dietary habits, underscores the importance of a holistic view when managing patients with significant unexplained weight loss and potential endocrine disorders.

References

• Bazzano, A., Monnette, A., Wharton, M., Price-Haywood, E., Nauman, E., Dominick, P., Glover, C., Hu, G., & Shi, L. (2019). Older patients’ preferences and views related to non-face-to-face diabetes chronic care management: a qualitative study from southeast Louisiana. Patient Preference & Adherence, 13, 901–911.
• Menzel, J., Biemann, R., Longree, A., Isermann, B., Mai, K., Schulze, M. B., Abraham, K., & Weikert, C. (2020). Associations of a vegan diet with inflammatory biomarkers. Scientific Reports, 10(1), 1933.
• Meurisse, M., Gollogly, L., Degauque, C., Fumal, I., Defechereux, T., & Hamoir, E. (2018). Iatrogenic thyrotoxicosis: causal circumstances, pathophysiology, and principles of treatment-review of the literature. World journal of surgery, 24(11), 1377–1385.
• Ni, M., Ayu, D., Wayan, N., & Gusti Putu Suka, A. (2020). Diabetes mellitus control among elderly patients at geriatric polyclinic of Karangasem District Hospital, Bali, Indonesia: a preliminary study. Bali Medical Journal, 9(1), 279–285.
• Pandiyan, B., Merrill, S. J., Di Bari, F., Antonelli, A., & Benvenga, S. (2018). A patient-specific treatment model for Graves’ hyperthyroidism. Theoretical Biology and Medical Modelling, 1.
• Pandiyan, B., Mahran, M., & Roman, C. (2020). Management of thyroid hormone levels in hyperthyroidism. Journal of Endocrinology, 245(3), 233-245.
• Soh, S. B., & Aw, T. C. (2019). Laboratory Testing in Thyroid Conditions - Pitfalls and Clinical Utility. Annals of Laboratory Medicine, 39(1), 3–14.
• Pimentel, M. (2016). Update on Irritable Bowel Syndrome Diagnostics and Therapeutics. Gastroenterology & Hepatology, 12(7), 442–445.

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