2. Chief complaints
A 55 year old female came with complains of
• Shivering of whole body since 8 months
• Weight loss of 25kgs in 2 months
• Generalised fatigue in 2 months
• Decreased appetite since 2 months
• Breathlessness on walking since 2 months
3. History of presenting Illness
• Patient was apparently normal 3 months back after which she
started developing history of breathlessness (mmrc 3) which was
insidious in onset progressive in nature and not associated with
fever,cough or sputum
• H/o back pain with b/l knee pain since 2 years
• No h/o night sweats , hemoptysis
• No h/o palpitations or heat intolerance
• No h/o any menstrual irregularities
4. Past History
• Known case of interstitial pneumonitis on treatment
• Known case of lumbar spondylosis on treatment
• No other known co morbidities
5. General Examination
• Patient is conscious, oriented , afebrile
• Pallor present
• No icterus, cyanosis,clubbing,pedal edema or lymphadenopathy
6. Systemic examination
• CVS: S1,S2 heard, apical impulse in left 5th intercostal space medial to
mid clavicular line, Ejaction systolic murmur at aortic area
• RS: B/L air entry present, no added sounds
• P/A: soft , non tender, no organomegaly
8. CNS
• Tone was found to be normal
• Deep tendon reflexes were normal
• B/l plantar was found to be flexor
• No cerebellar signs
• No signs of cranial nerve involvement
• No signs of sensory deficit
• Patient was found to have tremors
• Grovers sign positive
20. Course
After consulting endocrinologist, patient was started on
Carbimazole 10mg after food and propranolol 40mg after food
following which patient was symptomatically improved and was
discharged.
21. Mechanism
• Thyroxine (freeT4) induces disturbance of oxidative phosphorylation
which leads to muscle dysfunction
• Thyroid hormones increase lysosomal activity and release of amino
acid by proteolysis of muscle fibers
• Muscle atrophy is due to increased protein catabolism by effect of
thyroid hormones
