34 Year old female having lethargy and thyroid disease

This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here after collecting informed patient consent (form downloadable Click Here) by BMJ Elective Student.

Case Summary:

This 34-year-old female presented with sudden hand tremors 3 days back of the initial presentation and intermittent pre-syncope. She had a history of shoulder and neck pain. Her thyroid function was done subsequently with chest X-ray and cervical spine Xray (attached below). She was diagnosed with mild hypothyroidism subsequently after repeated thyroid evaluation done.

We reduced her thyroxine to 50mcg in June 2017 and she was doing fine until 1 month back when she has again developed the same lethargy she was experiencing in March 2017. On March 2017 the lethargy became better by 80% on increasing the dose but the tests became slightly overcontrolled so we reduced it again to 50 mcg which was fine till one month back when she again developed lethargy. So this time instead of jumping up to 75 mcg let's increase it to 62.5 mcg

Prescriptions chronological:

TEST results:

Complete blood count results:

Xray report of Chest P/A views and Cervical spine AP and lateral view:

Comments

55 years Old male with Bipolar affected disorder moving from depression to Manic to depression phase

Disclaimer:- This is a HIPAA de-identified open-online-patient-record with initial information in patient's voice, posted here December 2017 after collecting informed patient consent (form downloadable Click Here) This is a case of a 55 years old, diabetic, hypertensive patient who was diagnosed with Bipolar affected disorder since 1995. In 1995 due to financial loss he was attacked by this condition. He was seen by Dr. D. K Agarwala and diagnosed as BPAD-Depression phase and treated with lithium, sodium valporate, propranolol, Zeptol cr, Nitrosum - S. With the treatment he was reasonably well but every 6 months of interval he appeared to have some disturbance like didn't want to talk to anybody, forgot to smile etc. They went to the doctor and treated accordingly and was continuing the treatment. In the year of 2013, August he was diagnosed with BPAD-severe depression phase but, he was not responding well to the medications and then they went to NIMHANS for

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drugs to avoid or use in terms of their pregnancy category

The optimal AEDs therapy of women with epilepsy who are of childbearing age is unclear because of a lack of conclusive data on the comparative teratogenicity of different antiseizure drugs and no antiepileptic drug has proven safe in pregnancy in terms of teratogenesis. Data on the comparative efficacy of various antiseizure drugs for controlling seizures during pregnancy are also quite limited, and there are no randomized trials in this setting. Treatment must be individualized for all patients. Women with epilepsy are classified as high risk during pregnancy and as there are no clear data indicating that any drug is without risk in pregnancy therefore, the antiseizure drug regimen should be optimized six months prior to planned conception. Choice of antiepileptic drugs in women of childbearing age and pregnant women with epilepsy: 1. T he antiseizure drug that stops seizures in a given patient is the one that should be used with an exception of valproate. 2.

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