This case presentation describes a 43-year-old female patient who presented with neck pain, hoarseness, constipation, weakness, myalgia, dry skin, decreased appetite, and facial puffiness. Laboratory tests revealed low levels of T3, T4, and hemoglobin and elevated levels of ESR and TSH, leading to a diagnosis of hypothyroidism and anemia. Imaging showed spondylosis and mild dislocation in the cervical spine, indicating cervical canal stenosis. The patient was treated with thyroxine, vitamins, minerals, gabapentin, and amitriptyline and advised lifestyle changes and follow up.

1. CASE PRESENTATION
Cervical Canal Stenosis
Hypothyroidism
by
Nagaraju B

2. Patient Name
IP/OP No
DOA
DOD
Department
Unit
Age
Sex
Weight
-XXXX
-34436/13/14
- 15/02/2014
- 18/02/2014
- Med
- IV
- 43years
- Female
- 60kgs

3. SUBJECTIVE
Chief complaint/ History of Presenting illness:
h/o Neck pain since 4 months with radiating to right upper limb.
c/o Hoarseness of voice x 1yr
c/o Constipation since x 3 months
c/o Generalized Weakness x 2 months
c/o Myalgia x 1 month
c/o Coarse skin x 1month
c/o Decreased appetite x 1 month
c/o Facial puffiness x 5 days
Previous history:
Attained menopause 2 years back
Past MedicationHistory/Allergy:
Nothing significant

4. Family history:
Personal history:
no f/h/o DM, HTN, ASTHAMA, TB
Diet- Mixed
Appetite- Decreased
Sleep- Disturbed
Bowel – Constipation+
Bladder- Normal
Habits- None
OBJECTIVE
Physical examination :Conscious, co-operative, alert and oriented.
Vital signs:
BP - 116/80mmHg
RR – 18cpm
PR – 68bpm
Temp – afebrile.

5. P[+], I[-], C[-], C[+], L[-], E[+]
Systems:P/A
RS
CVS
CNS
NAD
Provisional diagnosis :
 ? Paresthesia+
 ? Hypothyroidism&
 ? Anemia

6. LABORATORY INVESTIGATIONS
TEST
TEST VALUE
NORMAL VALUE
Hb (g/dl)
11.9
12-16
TLC: (cells/cmm)
4500
4000-11000
DLC : N (%)
64
40-75
L (%)
28
20-45
E (%)
02
1-6
M (%)
05
2-10
B (%)
01
0-1
Platelets (cells/cmm)
1.8
1.5-4.0 lakh/cmm
ESR
21
0-20 mmhr
T3 (ng/ml)
0.14
0.60-1.81ng/ml
T4 (mcg/ml)
0.24
4.5-10.9mcg/ml
TSH (miU/L)
82.0
0.4-4.2miU/L
Radiogrphic
Imaging/MRI
Spondylosis changes in cervical spine Grade-I restore
C5 over C6 mild dislocate C4-5, C5-6 & C6-7 levelsNo significant canal/neural terminal compromise

7. ASSESMENT
Based on the subjective evidence[Hoarseness of voice,
Constipation, Generalized Weakness, Myalgia, Coarse
skin, Decreased appetite and Facial puffiness] &
objective evidence [ decreased levels of T3, T4, Hb and
elevated levels of ESR and TSH], the patient was
diagnosed to have Hypothyroidism with Anemia.
Radio Imaging & MRI shows that Spondylosis changes in
cervical spine Grade-I restore and C5 over C6 mild
dislocate C4-5, C5-6 & C6-7 levels of which can be
confirmed to have Cervical Canal Stenosis.

8. TREATMENT CHART
BRAND NAME
GENEROIC
NAME
DOSE
FREQU
ENCY
DATE
DATE END
T. Zentel400
Albendazole
400mg
0-0-1
15/2
---
T. Eliwel
Amitriptylline
10mg
0-0-1
15/2
17/2
T. Eltroxin
Thyroxine sod
100mcg
1-0-0
16/2
18/2
T. Gabantin Plus
Gabapentin+M
ethylcobala
100mg+
500mcg
1-0-1
17/2
18/2
C. Thirty Plus
Multivit& Min
--
0-1-0
17/2
18/2
MEDICINE ON DISCHARGE
(DAMA)
T. Eliwel
1hsod
T. Eltroxin
1od
T. Gabantin Plus
1hnod
C. Thirty Plus
10d
x 40days
Review on 01/4

9. PLAN
Suggestion to PhysicianNo drug interaction is found.
-Iron & vit-C preparations would have been advised.
-Investigation of Stool for ova and cyst would have advised.
-Hard cervical collar would have advised.
-Laxative might have been added whenever patient feels
constipation for time being.

10. Advice to patient Avoid rapid posture change.
 Try to relax whenever possible.
 Try to reduce stress & anxiousness, if any.
 Make habit of doing exercise at least 30 min daily.
 Adhere to medication.
 Maintain hygiene.
 Drink plenty of water.
 Take
orange juice and iron rich foods like
chicken, meat, egg and green leafy vegetables like
spinach and beetroot.
 Take thyroxine tablet on empty stomach
 Need not be worried, if stool become darker or yellowish
urination after taking 30+.
 Repeat TFT after 1-2 months as per convenience.

11. THANK YOU…