Case 1 – Feeling Slow

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.


  • 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


  • Comments on bradycardia
  • Assesses for orthostatic changes in vitals
  • States that temperature should be measured, and it may show hypothermia


  • 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