Gyne - Congenital Hypothyroidism
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SILLIMAN UNIVERSITY MEDICAL SCHOOL GYNECOLOGY WORKSHEET SUBMITTED to Dr. Daphne R. Rana SUBMITTED by (1) Cruz, Bea Celina; (2) de la Pena, Nesil; (3) de leon, Jan Gil; (4) de los Santos, Rosheil Mae I. HEALTH HISTORY A. IDENTIFYING DATA: A case of & year old female patient B. CHIEF COMPLAINT: Vaginal bleeding C. HPI: Brought for consultation because of vaginal bleeding described as cyclic vaginal bleeding for the last 3 months . The bleeding lasts 3-4 days per cycle with small amount of blood loss. The patient did not have a history of convulsions, meningitis, encephalitis, head injury or hormonal therapy. She was born at term pregnancy without any complications in apoor illiterate family. Her parents noticed tha she had slow mental and physical development since birth compared with her brothers and sisters. D. FAMILY HISTORY: There was no previous family history of similar condition. II. PHYSICAL EXAMINATION General Survey: Patient looked lethargic, pale with coarse features and puffy face Vital Signs: T: 36.8 0 C BP: 95/55 mmHg PR: 64/min RR: 20/min Weight: 18kg Height: 98cm Skin: (+)Increase in body hair growth mainly on her back Neck: No thyroid and lymph node enlarement Chest/CVS: Heart and chest are normal Breast: Breast buds were developed as tanner stage 2-3 without galactorrhea Abdomen: Distended; no abnormal pelvic and abdominal masses were palpated. Genital Exam: No abnormalities detected Extremities: No pitting edema III. PRIMARY WORKING IMP R/I R/O IV. DIFFERENTIAL Dx R/I R/O 1. V. LABORATORY TESTS and DIAGNOSTIC TESTS TEST RATIONALE VI. LIST OF PROBLEMS 1. VII. FINAL DIAGNOSIS: PRECOCIOUS PUBERTY SECONDARY TO CONGENITAL HYPOTHYROIDISM VIII. PATHOPHYSIOLOGY: According to Robbins and Cotran, hypothyroidism is caused by any structural or functional derangement that interferes with the production of adequate levels of
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Transcript of Gyne - Congenital Hypothyroidism
SILLIMAN UNIVERSITY MEDICAL SCHOOLGYNECOLOGY WORKSHEET SUBMITTED to Dr. Daphne R. RanaSUBMITTED by (1) Cruz, Bea Celina; (2) de la Pena, Nesil; (3) de leon, Jan Gil; (4) de los Santos, Rosheil MaeI. HEALTH HISTORYA. IDENTIFYING DATA: A case of & year old female patientB. CHIEF COMPLAINT: Vaginal bleedingC. HPI:
Brought for consultation because of vaginal bleeding described as cyclic vaginal bleeding for the last 3 months. The bleeding lasts 3-4 days per cycle with small amount of blood loss.The patient did not have a history of convulsions, meningitis, encephalitis, head injury or hormonal therapy. She was born at term pregnancy without any complications in apoor illiterate family. Her parents noticed tha she had slow mental and physical development since birth compared with her brothers and sisters.
D. FAMILY HISTORY: There was no previous family history of similar condition.II. PHYSICAL EXAMINATION
General Survey: Patient looked lethargic, pale with coarse features and puffy faceVital Signs: T: 36.80C BP: 95/55 mmHg PR: 64/min RR: 20/min Weight: 18kg Height: 98cm Skin: (+)Increase in body hair growth mainly on her backNeck: No thyroid and lymph node enlarementChest/CVS: Heart and chest are normalBreast: Breast buds were developed as tanner stage 2-3 without galactorrheaAbdomen: Distended; no abnormal pelvic and abdominal masses were palpated.Genital Exam: No abnormalities detectedExtremities: No pitting edema
III. PRIMARY WORKING IMP R/I R/O
IV. DIFFERENTIAL Dx R/I R/O1.
V. LABORATORY TESTS and DIAGNOSTIC TESTSTEST RATIONALE
VI. LIST OF PROBLEMS1.
VII. FINAL DIAGNOSIS: PRECOCIOUS PUBERTY SECONDARY TO CONGENITAL HYPOTHYROIDISM
VIII. PATHOPHYSIOLOGY: According to Robbins and Cotran, hypothyroidism is caused by any structural or functional derangement that interferes with the production of adequate levels of thyroid hormone. The causes of hypothyroidism is divided into primary and secondary causes.
Primary hypothyroidism can be congenital. This includes inborn errors of thyroid metabolism, thyroid dysgenesis, Mutations in thyroid hormone receptor-beta, thyroid agenesis and thyroid hypoplasia. Primary hypothyroidism can be acquired, caused by surgical or radiation-induced ablation of thyroid parenchyma and drugs to decrease thyroid secretion. Autoimmune hypothyroidism is the most common cause of hypothyroidism in iodine-sufficient areas (vast majority of cases are due to Hashimoto thyroiditis.
According to Berek and Novak's, secondary causes of hypothyroidism includes hypothalamic thyrotropin-releasing hormone deficiency and pituitary or hypothalamic tumors or disease.
Our patient manifests vaginal bleeding and this can be caused by long standing hypothyroidism most likely congenital hypothyroidism.
Decreased production of thyroid hormones (T3 & T4) causes an increase in the secretion of thyroid-stimulating hormone by the pituitary gland to stimulate production of thyroid hormone. There will also be an increase in thyrotropin-releasing hormone from the hypothalamus. Thyroid hormone activity is responsible for basal metabolic rate, mental and physical development. Since there is a decrease in thyroid hormone, the patient manifested signs and symptoms such as cold intolerance, short stature, coarse features, puffy face( decreased body temperature causes fluid retention), and mental retardation. Prolactin production can be stimulated by thyrotropin releasing hormone. Thus an increase thyrotropin releasing hormone, there will also be hyperprolactinemia as manifested by the patient.
A convincing explanation of sexual precocity and bilateral ovarian enlargement is that high levels of TSH could act through the follicle stimulating hormone receptor (FSH-r) and cause gonadal stimulation. This causes breast development, uterine bleeding and multicystic ovaries.
IX. THERAPEUTIC OBJECTIVESA. NON-PHARMACOLOGIC MANAGEMENT
1.B. PHARMACOLOGIC MANAGEMENT
DRUG EFFICACY SAFETY SUITABILITY COST
P DRUGS
X. MONITORING & FOLLOW-UP
XIII. PRESCRIPTION WRITING
Bea Cel ina Cruz , M.D.SILLIMAN UNIVERSITY MEDICAL CENTER
(035) 000 – 0000
Patient: Date: Address: Age/Sex:
Ketorolac (KETERO) 30mg/ml vial#Sig:Administer mg IV every 6 hours for 2 days
Bea Celina Cruz, M.DLic. No. 00000000
