A middle aged obese female ( BMI - 30) a k/c/o Hypothyroidism presented to ED with complains of Pain Right Hypochondrium, weight gain and Anorexia since 1 month....On examination, she was found to have Hepatomegaly (4 inches below the right costal margin)....USG and CECT W/A was done....Comment on the treatment approach to this patient...

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Seems to be she is suffering from Metabolic syndrome - Obesity, Dyslipedemia, Hypothyroidism and Fatty liver... Which is spectrum of NAFLD with raised AST ALT.. She needs treatment for Dyslipedemia, Hypothyroidism.. Weight reduction is required.. Follow up scan after 3 to 6 months..

Nonalcoholic steatohepatitis cld. Inadequate thyroxine supplementation. Dyslipidemia. Needs to rule out varices and pud by endoscopy. Check viral serology. PT with inr. AFP. B12. Check fbs plbs hba1c. Cortisol. Start udca evion

BLOOD = HBsAg HCV AB HAV IgM AB HEV IgM AB BLOOD SUGAR BLOOD LIPIDS CREATININE GFR BP TO RECORD URINE PROTEIN 24 HRS = CARDIOMETABOLIC SYNDROME TO BE EXCLUDED FIBROSCAN LIVER HER BP TO BE RECORDED URINE PROTEIN OBESE HYPOTHYROID NAFLD WITH RAISED TRANSAMINASE LEVELS = ALT & AST DISPROPORTINATELY RAISED THAN ALP = SUGGESTIVE HEPATOCELLUR DYSFUNCTION PAIN ABD IS DUE TO HEPATOMEGALY VIRAL HEPATITIS NEED EXCLUSION FOR ANOREXIA HYPOTHYROIDISM IS CAUSE OF HER WT GAIN RX 1THYROXINE TAB 2 WT REDUCTION 3 VIT E VIT D ROSUVASTATIN PENTOXYPHILLINE MAY BE GIVEN IN HEPATIC STEATOSIS URSODESOXYCHOLIC ACID HAS NOT BEEN FOUND TO EFFECTIVE

It's case of metabolic syndrome . Treat hypothyroidism , dyslipidemia . Advice wt. reduction , low spicy & fatty diets.

FT4 is high, and Tsh also high.. needs further drug history. Also rule out any TSH PRODUCING ADENOMA OR TUMOR.

Viral hepatitis with dyslipaedimia with hypothyroidism and ECG and abg should b done

diagnosis of metabolic syndrome (previously known as syndrome X) where three or more of the following risk factors are present: central obesity elevated triglyceride low HDL raised blood pressure raised fasting plasma glucose

Anti hypothyroid drugs, check blood sugar, case of metabolic syndrome.

What was the need for CT is beyond my understanding. Still discharge the patient, Start Lifestyle modification, weight loss, treat dyslipidemia and DM appropriately. Titrate hypothyroid treatment. Free T4 would have been more than sufficient. Checking TFT in setting of acute conditions ia not avoidable.. Results will he highly variable always. Repeat after 1 month

Seems like academic of Metabolic Syndrome along with Hypothyroidism and NAFLD. Please assess glycaemic status Adjusting dose of LT4 Life style and dietary modifications , weight loss

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