Pls help me figure this out

[Madhatter]

hi! could someone be so kind as to help me out with a difficult case. a 53 yo woman has a lack of interest in things, lack of patience, strong anger fits, bitterness, complains of freezing feeling traveling up from the base of her neck upwards in her brain, and also forgets roads that she travels on frequently. what could this be??

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[lowbudget]

Psych: Possible grief/adjustment d/o/depressive episode/undx bipolar. Also possible early dementia (?). H: ask h/o seizures, focal neuro deficits, chronicity of symptoms, recent life events. PE: Folstein MMSE, Neuro exam. Check TSH/free T4, electrolytes, BUN/Cr, thiamine, glucose, B12, folate. Also review medications.

Just my amateur opinion.

 

[dr.smurf]

i agree with the above post on the strong likelihood of depressive episode +/- anxiety. remember common things happen commonly and people present very differently. you must rule out an organic cause with your tsh, etc. you may eventually consider a head ct to r/o a frontal lobe lesion, although this should be further down on your work up list.
good luck..

 

[Madhatter]

i found out that she does have hypothyroid, but is on medication for that. but what effect could hypothyroid have on the symptoms i listed in the original post??

 

[erichaj]

If she does not have hypothyroid disease and she is on thyroid medicine, then she is getting a hyperthyroid disease that can have many of the symptoms of hypothyroid disease.

Start with TSH. If low, then take pt. off the thyroid medicine slowly. Repeat tsh in 6 weeks and again 6 weeks. She should have symptom resolution after this. If this does not happen, then give depression inventory and trial of SSRI. No SSRI if pt. has any signs or sypmtoms resembling manic episodes. SSRI can cause manic episodes.

EH, M.D.