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Case Studies 7

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     A 32 year old man presents with heat intolerance and weight loss. His symptoms started about three months ago and have been getting worse. He has lost ten pounds in the last six weeks but says his appetite is very good. He says he is always hot, even in air-conditioned rooms. After questioning, he also admits to having increased nervousness, trouble concentrating, and palpitations. Physical exam reveals a patient with warm, smooth, moist skin and a diffuse goiter with a palpable thrill and bruit. Neurological exam showed a fine tremor and fast return phase for deep tendon reflexes.

 1.  What do you suspect is the problem?

 2.  What lab tests will confirm this?

       A 43 y/o patient with the chief complaint of "decreased energy." She complains of fatigue, inability to finish tasks, sleeping more, yet always being tired. She has also noticed a decreased cold tolerance, constipation, and dryness of the skin. She comments that she is always cold, even in the summer.

 3.   What do you suspect is the problem?

 4.  What lab tests will confirm this?

42 yr. old woman was seen for her routine yearly exam. She denies any symptoms of hyper- or hypothyroidism. A small diffuse goiter is found on physical exam, otherwise the exam is normal.  

 5.   What do you suspect is the problem?

 6.  What lab tests will confirm this?

A 12-year-old girl is noted to be pale and lethragic by her parents. Parents also report a loss of appetite. You note some petechiae on her legs.   Physical exam reveals enlargement of lymph nodes in the neck, the arm pit, and throat, and an enlarged spleen. A chest roentgenogram is normal.  A CBC revealed a WBC of 25.0 x10³ /L with 15% blasts and anemia.

 7.  What do you suspect is the problem?

 8.  What lab tests will confirm this?