A 35-year old Caucasian female comes to a walk-in clinic complaining of feeling

Question

A 35-year old Caucasian female comes to a walk-in clinic complaining of feeling tired and cold constant She also fe she feels.cold-all trying to lose weight by "dieting by restricting her food intake but does not do any physical exercise regularl because she said she just doesn't have the energy to exercise. She doesn't smoke or drink alcohol. She is married with one 10-year old son who suffers mental retardation and stunted growth. Her husband works in construction, while she is an administrative.assistant at a local public school. She denied having heart problem, and her menstruation has been irregular as always since she got it the first time when she was 13 years old. She is a new immigrant to the US with her family, she comes from a very dry mountainous her country, where she said many people there has gland enlargement in their neck. She claimed that sh doesn't have time to cook for her family because of her full time job and also taking care of her disable child Her common diets include rice as her staple food often with canned foods (beans or preserved meats all the time and not up to doing any outdoor activities during her spare tme becau the time. She claims she has been healthy all her life, and since a year ago she has been Physical exam (unds-ro diferenhul diagnosis) . Temperature: 36° Celsius (normal: 36.10.37.2 Blood pressure: 100/65 mmHg (normal: 120/80 mmHg) heart rate: 50 beat/minute (normal 60-100 x/minute) respiratory rate: 20/minute (normal 12 -20 x/minute) An obese looking woman, with normal insight into place, time and people There is a soft mass in her left lower neck, most likely her thyroid gland, size 2x2x1 cm. No pain on palpation. .Her palms are dry and feel cold to touch. Heart: heart sounds regular, no murmurs. No heart enlargement

Explanation / Answer

Reading her clinical picture the following differential diagnosis can be considered;

1.Hypothyroidism - the following clinical features resembles the condition

- Soft mass in lower left neck, most likely her thyroid gland

- Irregular menstruual cycles due to inadequate thyroid hormone to run the body's metabolism

- Palms are dry and cold to touch because in hypothyroidism the peripheries become intolerant to cold

- An obese looking woman, weight gain is mostly a common feature of this condition.

- Feeling tired and sleep and feeling constantly cold

2) The second possible diagnosis could be goitre because of the following features;

- Swelling over the lower left neck is a typical feature in goitre

- The client hails from a mountainous regions of her country, possibility of lack of iodine in diet

3) Third possible diagnosis could be thyroid nodule or thyroid cancer representing features of neck swelling,feeling tired and sleepy. Moreover, Caucasian ethnicity has higher incidence of thyroid cancer.

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