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.
When he was in class 7 (aged 12 years), he started to get lethargy, fatigue, low IQ, less active, angriness, increased hunger with increasing weight gain. When he was about to start his 8th standard classes, he was taken to a local doctor who diagnosed him with hypothyroidism. The local doctor prescribed him 50 mcg thyroxine and when he was taken to another doctor for a second opinion, the doctor increased the dose to 150 through 75 mcg. Which they continued with repeated follow-up and after checking with the tests. The dose was increased as per the doctor is due to his growing age (that doctor also said if he takes this medicines for 2 years, it will be cured). They continued at this dose (150 mcg) for 1.4 years followed by 175 mcg (due to derangement in the thyroid profile as evidenced by the reports) which he is continuing till now. He has no known family history for any thyroid disorders. After starting thyroxine therapy, he appeared to have decreased laziness for the first month. Then after no improvement was noticed and since then his weight has been increasing, which was 54 KG in February 2017 but has increased to 73.5 KG now.
When he was in class 7 (aged 12 years), he started to get lethargy, fatigue, low IQ, less active, angriness, increased hunger with increasing weight gain. When he was about to start his 8th standard classes, he was taken to a local doctor who diagnosed him with hypothyroidism. The local doctor prescribed him 50 mcg thyroxine and when he was taken to another doctor for a second opinion, the doctor increased the dose to 150 through 75 mcg. Which they continued with repeated follow-up and after checking with the tests. The dose was increased as per the doctor is due to his growing age (that doctor also said if he takes this medicines for 2 years, it will be cured). They continued at this dose (150 mcg) for 1.4 years followed by 175 mcg (due to derangement in the thyroid profile as evidenced by the reports) which he is continuing till now. He has no known family history for any thyroid disorders. After starting thyroxine therapy, he appeared to have decreased laziness for the first month. Then after no improvement was noticed and since then his weight has been increasing, which was 54 KG in February 2017 but has increased to 73.5 KG now.
After repeat history, his father mentioned that his birth was uncomplicated but had a low birth weight. As he grew up, he was attentive to his studies and active until the age of 12 years when he started developing the symptoms mentioned above. His father shared a concern that he started gaining weight after taking wysolone (10 days) prescribed for his cough (normal PFT followed by inhaler by another doctor as it was not relieving) by a local physician. This prednisolone was prescribed even before he was diagnosed with subclinical hypothyroidism. Since then his weight is increasing and now it is 73.5 KG and height is 5.65/7 feet. Recently doctor’s found an elevated systolic BP (140/80 mm Hg) [which his father reports may be due to anxiety from abnormal thyroid profile] and fatty liver disease on USG. His father also reports foul smelling urine recently. His bowel habits are normal.
1st report as on 7.2.17:
1st prescription:
2nd report as on 16.5.17:
2nd prescription:
3rd report as on 19.5.17:
4th report as on 23.6.18:
Prescription as on 23.6.18:
5th report as on 9.1.18:
Latest prescription as on 9.10.18:
URINE R/E and CBC reports are pending (will update asap available).
Concerns:
1. His father is concerned and in a dilemma, if he is getting right management (right drugs, right dosages) of his son's problem!
2. He is also concerned if the current low TSH value will harm him as he is a student.
3. Really looking for a fast response as time is just increasing his anxiety.
Comments
Post a Comment