A 47-year old female patient presented with hoarseness of voice, constipation, generalized weakness, myalgia, coarse skin, decreased appetite, and facial puffiness for 1-3 months. Physical examination and laboratory test results found decreased levels of T3, T4, hemoglobin, MCV and MCH, and an elevated TSH. Based on these subjective and objective findings, the patient was diagnosed with hypothyroidism and anemia. She was prescribed levothyroxine, ferrous sulfate, and advised to follow a healthy diet and lifestyle to manage her conditions.

1. CASE PRESENTATION
HYPOTHYROIDISM
with ANEMIA
Nagaraju B

2. Patient Name - xxxx
IP/OP No
- 16881/13
DOA
- 4/8/13
DOD
- 8/8/13
Department
- Medical
Unit
-I
Age
- 47yr
Sex
- Female

3. SUBJECTIVE
Chief complaint/ History of Presenting illness:
C/o
Hoarseness of voice x 1yr
Constipation since x 3 months
Generalized Weakness x 2 months
Myalgia x 1 month
Coarse skin x 1month
Decreased appetite x 1 month
Facial puffiness x 5 days
Previous history:
Attained menopause 2 years back
PastMedicationHistory/Allergy:
Nothing significant

4. Personal history:
Diet- Mixed
Appetite- Decreased
Sleep- Disturbed
Bowel- Constipation+
Bladder- Regular
Habits- None
Family history:
no f/h/o DM, HTN, ASTHMA, TB
OBJECTIVE
Physical examination :A 47 year old female patient
moderately built, conscious, cooperative and alert.
Vital signs:
BP – 110/70 mmHg
RR – 17cpm
PR – 60 bpm
Temp – afebrile.

5. P[+], I[-], C[-], C[+], L[-], E[+]
Systems :
P/A - soft, non-tenderness.
RS - NVBS+ , no additional sounds.
CVS – S1S2 + , no murmurs.
CNS -HMF - N
cranial nerves – N
No sensory/ motor deficit.
Provisional diagnosis : Anemia,
Hypothyroidism ??

6. LABORATORY INVESTIGATIONS
TEST
TEST VALUE
Hb (g/dl)
TLC
(cells/cmm)
8.9
4500
NORMAL VALUE
12-16
4000-11000
DLC
N (%)
40-75
78
L (%)
20
20-45
E (%)
02
1-6
M (%)
00
2-10
B (%)
00
0-1
Platelets (cells/cmm)
1.8
1.5-4.0 lakh/cmm
ESR
15
0-20 mmhr
MCV (fL)
76
84-96fL
MCH(pg)
20
28-33pg
Bl Grouping & Rh
B+

7. TEST
TEST VALUE
NORMAL VALUE
RBS
143
80-140mg/dl
Bl. U (mg/dl)
28
12-40mg/dl
Sr. Cr (mg/dl)
1.3
0.2-1.4mg/dl
T3 (ng/ml)
0.14
0.60-1.81ng/ml
T4 (mcg/ml)
0.24
4.5-10.9mcg/ml
TSH (mIU/L)
8.2
0.4-4.2miU/L
Urine Routine
Sugar: Nil
Albumin: Traces
Urine Microscopy
NAD
CXR
NAD

8. 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, MCV, MCH, Hb and elevated level
of and TSH], the patient was diagnosed to have
Hypothyroidism with Anaemia

9. MEDICATION CHART
BRAND NAME
GENEROIC NAME
DOSE
FREQU
ENCY
DATE
DATE END
T. Zentel400
Albendazole
400mg
0-0-1
4/4/13
T. Eltroxin
Levothyroxine
Sodium
100mcg
1-0-0
4/4/13
Contd-
T.FS
Ferrous
sulphate.
200mg
1-0-0
4/4/13
Contd-
Noni fruit juice
Morinda
citrafolia.
15ml
1-0-1
4/4/13
Contd-

10. PLAN
Suggestion to Physician-No drug interaction was found.
-Suggest to administer vit-C tablet as it increases the
absorption of iron.
-Levothyroxine interact with iron supplements; it should
be administrated at least 1-2 hrs. before taking iron
containing preparations.
-Investigation of Stool for ova and cyst would have
advised.

11. Advice to patientAdhere 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 levothyroxine tablet on empty stomach.
 Need not be worried, if stool become darker after
taking iron tablet.
 Repeat TFT after 1-2 months as per convenience.


12. THANK YOU…