40 year old female with periorbital puffiness and peripheral neuropathy

This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.


This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.


I have been given this case to solve in an attempt to understand the topic of " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan.

Patient and his/her attenders have been informed and their consent has been taken


40 year old female agricultural labourer by occupation came with complaints of 

Puffiness around eyes since 2months

Tingling sensation over both lower limbs since 2 months

Shortness of breath since 2 months 

joint pains since 2 months

HISTORY OF PRESENTING ILLNESS 

Pt was apparently asymptomatic 2 months back then she developed puffiness around eyes which is more at the end of the day , aggravating with work and cold temperature , relieved on taking rest. 

She also developed shortness of breath even with regular normal activities , generalised weakness and difficulty to perform her everyday activities

Past history

No similar complaints in the past

No history diabetes, asthma, hypertension, epilepsy,CAD , CVA , thyroid disorders

Personal history

was married at 7 years age 

Lost her husband 15 years ago

Appetite : Normal

Bowel and bladder movements : regular 

Sleep : adequate

No addictions 

General examination

Patient is conscious, coherent and co operative well oriented to time, place and person

Pallor present

No icterus, cyanosis, clubbing, generalised lymphadenopathy, pedal edema

Bilateral peri orbital puffiness present 



Systemic examination :

CVS:

S1 , S2 heard

no murmurs



Respiratory system:

trachea central 

bilateral air entry present 

normal vesicular breath sounds heard 

Abdomen examination:

scaphoid shape

no tenderness, no palpable mass


Central nervous system:

patient is conscious 

speech- normal 

no focal neurological deficiet 

higher mental functions are intact

Reflexes
                             R.                     L
 Biceps -                ++                     ++

Triceps                     ++                    ++

supinator-                  +                     +

knee -                       ++                   ++

ankle-                  +                             +

Delayed recovery of reflexes present
kneeling ankle reflex


Provisional diagnosis
Differentials:
Nephrotic syndrome
?Heart failure


On investigations thyroid function was deranged 

USG NECK

2D echo report 

Diagnosis:
PRIMARY HYPOTHYROIDISM 

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