You are seeing Mrs. Rostov, a 61 year old woman, because she feels slow. Take a focused history, and perform a physical exam pertinent to her complaint.
History
- Clarifies patient’s recent symptoms of fatigue
- Onset and duration of symptoms
- Asks about sleep habits
- Cold intolerance
- Dry skin
- Weight gain
- Hair loss
- Abnormal vaginal bleeding
- Muscle cramping
- Exercise intolerance
- Constipation
- Mood changes
- Poor focus
- Smoking and alcohol history
- Personal history of thyroid disorders
- Radiation to Head and Neck
- Family history of thyroid disorders
- Family history of auto-immune disorders (Type I Diabetes, Celiac Disease, Addison’s Disease, Rheumatoid Arthritis)
- Current medications
- Effect on daily activities
Physical Examination
Vitals
- Comments on bradycardia
- Assesses for orthostatic changes in vitals
- States that temperature should be measured, and it may show hypothermia
Inspection
- Comments on hair changes (thin)
- Assesses for skin changes, including dryness, and pretibial myxedema
- Edema (face and lower extremities)
- Comments on nail changes (brittle nails)
- Hair loss
- Assesses swallowing
- Proximal muscle wasting
Thyroid Examination
- Inspects for enlarged thyroid
- Observes thyroid while swallowing
- Palpates both thyroid lobes
- Comments on size, texture, and nodularity
- Palpates anterior cervical nodes for abnormality
Neurological Examination
- Reflexes (may be hyporeflexive)
- Proximal muscle power (may be decreased)
Case 1 – Feeling Slow