1. EACH PATIENT - AN OPEN BOOK Interesting Clinical Cases
Dr. R.V.S.N.Sarma., M.D., M.Sc., (Canada)
5 Jayanagar, Tiruvallur
Mobile
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2. Clinical Problem Middle aged lady Obesity Depression What was wrong ?
How she was investigated ?
What was the outcome ?

8. Summary of the evaluations
Clinical Presentation
48 year lady
80 kg weight
Lack of interest
Lethargic, Indolent
MDD score high
Clinically Hypothyroid
Investigations
TSH very high > 100
T3, T4 and FT4 very low
LDL 171 mg
TC 267 mg
Eltroxin 50 – 300 mcg
Atorvastatin 10 mg

16. How is she today ? Follow up Investigations 49 year lady
61.9 kg weight
Normal and active
Anaemia improved
No depression signs
Clinically Euthyroid
Investigations
TSH ↓ (over corrected)
FT4 and FT3 not done
LDL 85 mg
TC 168 mg
HB 12 g %
ECG N – HR 88/mt
↓ Eltroxin to 200 mcg
Stop Atorvastatin

17. What are the messages ? Hypothyroidism is an under current
Unless suspected we will sure miss it
Depression and hypothyroid are associated
Pregnant / Middle aged women and
Obese individuals need thyroid evaluation
↑ in LDL and TC may predispose for IHD
Start low and Go slow, TSH for follow up