Hypothyroidism?

She is known c/o htn on rx tab telvas-ct 1od Pmh of fatty liver on tab openup 150mg 1bd Cap panrop dsr 1od Over weight and obese Chief Complaints Horsness of voice developed recently 2to 3 weeks Vitals Temp 97.6f Bp 120/80mm Heart rate 85bpm Sp02 97% Physical Examination Wt 79kg height 152cm Chest is clear heart s1s2 L0S0K0 Hyperpigmentation stasis dermititis seen on lower limbs no swelling or pitting oedema No signs of dvt Investigations Hb12.8gm TLC 5900 DLC p54 l42 e03m01 b0 Esr15mm Bsl f 103 pp 105 TC 248mg TG 116MG HDLC 58MG VLDL 23.2MG LDL166.8MG URINE NAD TFT T3 0.69NG T4 10.59UG TSH 1.87UIU ANTI TPO 580.34IU (N 0 TO 5.61 IU) USG NECK FOR THYROID NORMAL STUDY ECG NSR AND WNL Diagnosis ?subclinical hypothyroidism With htn Management I have put her on Rx tab methimezol 5mg 1od Rest are continued DISCUSSION ? Is it a c/o hypo or hyper thyroidism Thyroditis

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Hashimoto's thyroiditis. TPO antibodies are high . This will be brittle thyroid condition, will easily swing between hypo and hyperthyroidism. Suggest 1) Free T3 , and Free T4 . Thyroid profile to be repeated after 1 month . 2) ENT check up to rule out local ENT cause for hoarseness. Laryngeal nodule is possible. Xray sinuses to rule out ch sinusitisk. 3) Keep in mind myasthenia gravis and rule it out . 4) Till results come ,suggest, voice rest, antihistamines , steam inhalation

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So far investigation is concerned the case is Hashimoto's thyroiditis or Graves disease But presenting symptoms is hoarseness of voice. Some case may represent in hypothyroidism due to loss of frequency in voice Again it may happen in mostly obese personal as in this case due to narrowing of laryngeal lumen. Sometimes in case of bulbar palsy also. Very rarely in laryngeal amyloidosis may be seen. Overall local cause is very important for such symptoms, should be examined by ENT specialist to exclude laryngopharyngeal cause including any growth Again Free T3, T4 should be done Yes it may be found in Myasthenia gravis So further workout is necessary. I think L-thyroxin in minimal dose as 12.5 mcg may be started

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With the available reports, it is ckear that the Thyroid Function Tests of the patient are normal.... which essentially rules out Hypothyroidism.... For subclinical hypothyroidism, TSH needs to be raised but is typically less than 10... No need to start any anti thyroid drug which will cause undue suppression of TSH and pt will land into drug induced thyroid suppression

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Sir Please try this before come to any farthest conclusion Injection Lyncomycin 2ml IM OD for 5 days Tab Moxikind CV 625 1bd for 5 days or Tab Azithromycin 500 od for 5 days, Tab Prednisolone 10mg bd for days, gargle with salt and alum mixed warm water thrice a day

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Horseness of voice seen in hyperthyroidism. For differential diagnosis: Laryngitis Vocal cord nodule Upper respiratory infections Laryngeal edema Reflux laryngitis Reinke's edema Laryngeal nerve palsy Functional

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It is a case of hypothyroidism and required to rule out the causes of hoarseness of voice

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As the thyroid function test reports are normal we cannot tell it to be a hypothyroid or hyperthyroid but as the anti TPO antibodies are hai patient may develop hypothyroid lette jbr on so thyroid function test specially ft3 ft4 and TSH should be repeated every six months in future and hoarseness should be ruled out by a rigorous investigations and consultation by a ENT specialist.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

Thanx curofy for regards and respect
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Any hoarsness more then 2 week to r/0 cancer of larynx Hy pothyroidism with pmh of fatty liver

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Better do a free T3, free T4, TSH

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