1 Feb 2024 • It's a warm Monday afternoon and you are sitting in your office waiting for the next patient. ☀️

You lean in to check the medical record on your computer to find that the next patient is a 50 year old woman named Ann and she is complaining of feeling tired and cold from the past few weeks. 🖥️

Tired? Cold? During one of the warmest summers the city has experienced?! 🤔

No, this doesn’t seem right. Let’s ask the patient for more details…

Ann is a 50 year old housewife complaining of constant fatigue since the past few weeks. 😩

She also mentions that every time she stands up after being seated for a while, she’s been feeling dizzy as well. As she talks, you also make note of her slow speech. ✍️

Her husband, who has accompanied her to this visit, mentions that his wife’s voice seems different and slightly deeper since the past few days. “Also she seems to have gained some weight, when she’s never been a big eater !”

He also mentions that while he prefers to turn on the air conditioning during summer, Ann strangely seems to feel cold “all the time”. 🥶

By now you have an idea of the problem and you turn to Ann and ask her, “Is anything else bothering you?” 🧐

As she rubs her chin to think, you notice her skin, which seems to be dry and almost brittle.

Having given it some thought, she hesitantly mentions that she has been feeling constipated.

So let’s look back:

Here’s a 50 year old housewife complaining of fatigue, postural dizziness, slow speech, progressive weight gain, deepening of her voice, dry skin, constipation, and cold intolerance 📖

Yes, that's right! This seems to be a case of Hypothyroidism ✅

After an effective history, we can move on to physical examination and laboratory investigations, most importantly thyroid function tests ☑️

🩺 Physical examination: Vital signs include a temperature 96.8oF, pulse 58/minute and regular, BP 110/60. She is moderately obese and speaks slowly and has a puffy face, with pale, cool, dry, and thick skin. The thyroid gland is not palpable.

💉 Laboratory studies: CBC and differential WBC are normal. The serum T4 concentration is 3.8 ug/dl (N=4.5-12.5), the serum TSH is 5 uU/ml (N=0.2-3.5), and the serum cholesterol is 255 mg/dl (N<200).

High TSH, Low T4….Are we looking at a case of Primary Hypothyroidism?

What about instances where in TSH is low, and T4 is high? Or both TSH and T4 are low?

You can put your confusion to rest with this session on Interpretation of Thyroid Function Tests by Dr. Rohit Jacob.

🔗Click here to watch the replay right here on Medflix! 🤗