Popping out shortly but woke this morning absoloutely livid after receiving a letter sent to my gp from the endo i saw 22nd Jan letter typed 18th feb.
Thank you very much for referring this 46yr old lady to the endocrine clinic who i saw today. She told me she had been diagnosed with hyperthyroidism in 2003 (Hyothyroid!!) since then she has been on thyroid supplements. She says her main concern is her weight gain. (Not true. I said it was the tiredness). She has tried all methods to lose weight without success. She ttold me she was on slimming tablets back in September last year, which did not help. She walks 5 miles a day and eats a healthy diet. She has gained nearly 7 stone (it is actually 8 stone) in 6 years. Her main weight gain is around the neck (what?? I said stomach). She also told me she has been having headaches for the past few months ( no, i have always had headaches) she has a headache on ththe right side which is associated witn nausia. She denies any visual disturbances. She denies any photophobia or phenophobia. Her headache occurs in the morning and she sometimes takes nurofen for it. She also mentioned that she feels tired all the time even after 9 hours sleep. She denies having nightmares. She says she snores a lot (????). She also mentioned that she has had leg swelling for the past 5-6 years and has swollen feet and hanDs for the same time. She has shortness of breath after walking nearly25 steps on a flat surface which improves if she continues to walk. She denies any orthopnoea although she sleeps upright for comfort. She denies having bowel symptoms. She has a history of hair loss and easy bruising.
On further quetioning she told me that she is not enjoying life recently (because of the tiredness!!!) She used to do a lot of thi gs in the past but is now unable to do everything. She does not think she is depresed.
She has a past medical history of hyperthyroidism (HYpothyroid!,) diagnosed in 2003, menieres disease, CKD stage 3 _recently dignosed as per patient. She had a bebreast reductio surgery back in 2003 which was uncomplicated. She does not smoke or drink alchohol. She is not allergic to andany medication. She is a H&S supervisor at a solicitors however her main work is desk job.
She is on levothyroxine 100mcg per day. She is on dessixdessicated thyroid purchased on internet. She is on vitamin b12 tablets vitamin b3 (should be D3) selenium and b complex tablets. I also told her that i am not sure about the benefits of using dessicated thyroid. Also explained that sometimes a supplement can cause harm ( LIAR!,, she didnt even know what it was!!! She asked me to show her the bottle)..
On examination she looks anxious. Pulse 96 per min regular and blood pressure 180/100 she told me her blood pressure was always high in the surgery however it is normall range when she measures at home. Jvp is not raised. Her chest is clear. She has Swelling up to the knees. Her abdomen is soft and non tender. I noticed striae over the lower abdomen (?) . I also noticed erythematous rash over the anterior chest and behind the ear and the neck. Mrs xxxx was not aware of this rash and thinks whenever she is nervous it appears.
Today i have repeated her bloods including thyroid function tests. Full blood count. Hba1c, cortisol levels. I will see her with the results of the above tests in 10-12 weeks time.
P.s i can not see thyroid result on the system, i have attached a blood form for patient to repeat blood test (thanks for that! Shlep all over town again!!)
So there you go!!! I will post the results of all the other blood tests on a seperate post. Any comments welcomed.