Hypothyroidism

50 year old female comes into your practice complaining of constipation

Stem:
You are a 50 year old female who has been feeling generally unwell over the past months.
One of your main issues is constipation. You have been opening your bowels only 2x a week
(before, BO daily) for the last 2 months. No changes to the stools themselves (nil blood or
mucus). You have not experienced any abdominal pain; no associated nausea or vomiting

You have a reduced appetite, but despite this have put on 4kgs over the past 3 months. You
have a gluten free diet due to your coeliac disease but no drastic changes to your diet have
been made. You’ve also had a lower mood than normal and find that you have to put on more
layers when going out, even more so than normal. You also feel a lot more tired than usual –
and feel tired all the time.

You have also noticed that your periods are getting a lot heavier than usual.
You haven’t felt guilty about anything, there has been no triggers in the past few weeks. You
find yourself too tired to concentrate at work (work as an accountant).
There have been no changes to your medication

PMHx:
Coeliac Disease
Hypertension
Anxiety

Meds
Sertraline
Perindopril

All
NKDA

SHx:
Consumes etOH - 5 drinks/ week
Smokes 10/ day for 10 years

FHx:
Nil

Physical Examination:
(only state findings if asked for)
 Overweight female with dry skin
 Nil obvious pallor
 Dry skin and hands
 Eyes of normal appearance. Nil ophthalmoplegia/ double vision/ nil lid lag
(hyperthyroid signs)
 No obvious neck swellings. Pemberton’s negative
  Heart sounds dual
 Chest clear
 Abdomen Soft, non-tender. Bowel sounds present
 Some proximal muscle weakness
 Sluggish reflexes

Investigations:
Bloods: thyroid function tests (TSH), CBE, EUC
Thyroid autoantibodies
Hypothyroidism marking rubric
History:
 Student has systematic approach to history
 Student has asked appropriate questions regarding
constipation and fatigue
 Shows appropriate questioning for appropriate differentials

Physical exam:
 Student asks for appropriate findings
 Follows systematic approach

DDxs:
 Hypothyroidism
 Anaemia
 Depression
 Hypercalcaemia (3rd year case)

Student displays good reasoning through differential diagnoses

Student shows displays professionalism

GRADE
Student exceeds expected level for Year 3 A
Student performs at expected level for Year 3 B
Just reaches expected competency for Year 3 C
Below expected competency for Year 3 D
Far below expected competency for Year 3 E