Patient V.

, 46 years old, consulted an endocrinologist with complaints of general weakness, the

appearance of edema on the face and lower extremities, drowsiness, and overweight.

Anamnesis: The patient lives in an endemic area. Since childhood, he notes difficulties in mastering
educational material. Over the past year, he notes an increase in fatigue and an increase in general
weakness, in addition, a gradual increase in body weight by 8 kg over the past year. For about 2 months,
the appearance of edema on the face and legs worries. Heredity is not burdened. Denies concomitant
pathology.

Physical data: The general condition of the patient is satisfactory. Height - 174 cm, weight - 86 kg, BMI -
28.6 kg / m2. The patient is lethargic, apathetic, answers questions slowly. The skin is dry, pale, in the
area of the elbows there is a thickening of the skin. The thyroid gland is enlarged (WHO grade 2), dense,
mobile, painless. Nodules are not palpable. Swelling of the face, arms and legs. BP - 110/80 mm Hg. Art.,
pulse - 50 per minute, NPV - 17 per minute. Heart sounds are muffled. Vesicular breathing, no
wheezing. The tongue is thickened. With tooth facets. The abdomen is soft and painless on palpation.
The liver and spleen are not enlarged.

Laboratory data:

Complete blood count: • hemoglobin - 108 g / l; • erythrocytes - 4.31012 / cell; • leukocytes -

6.2109 / cell; • platelets - 380 thousand; • ESR - 12 mm / h. Biochemical blood test: • glucose - 5.0
mmol / l; • cholesterol - 8.1 mmol / l, LDL - 5.4 mmol / l; • total protein - 76 g / l; • AST - 20 mmol / L,
ALT - 18 mmol / L; • creatinine - 74 mmol / l; • urea - 5.1 mmol / l.

Hormonal blood test: • TSH - 24 mIU / l; • Free T4 - 6 pmol / l.

Questions:

1. Formulate and justify the diagnosis.

2. Suggest a plan for further investigation.

3. Determine the tactics of treatment.

4. Name the examinations required for further monitoring of the patient.