These hyperthyroidism case reports are part of the integrative case based reasoning archives toward developing contextual connectionist data driven outcomes for a spectrum of patients with hyperthyroidism:
Case 1:
Case 2:
Subclinical hyperthyroidism:
PaJR Conversational Transcripts (edited meticulously toward deidentification):
[15/04, 13:52] patient 38F: Dr asked to show her reports via mail. Will get them in 3-4 hours. Didn’t get the usg done
[15/04, 16:23]cm: Thyroid tests?
[15/04, 16:42]cm: Oh had missed that!
While it looks like biochemical hyperthyroidism you appear to be having clinical hyperthyroidism features in your symptoms of weight loss.
We generally check our patients if they have eye signs, thyroid swelling or fine tremors etc to determine clinical symptomatology which your local doctor will perhaps look for when you visit her
[15/04, 17:18] patient 38F: She did and since she did not write it down that was all normal!
[15/04, 20:56] patient 38F
: Docs ask
[15/04, 21:47]patient 38F
: Do I need it?
[16/04, 06:24]cm: I may not have asked for it as it may not change my treatment plan which would simply be meticulous follow up at this point of time.
Any serial objective values of the patient's weight over the last few months?
[16/04, 07:39] patient 38F
: Since I started food changes with a dietician last 6 months
[16/04, 07:40] patient 38F
: Last few days noticed when I was in ...
March around 64.4kg
7th April -63.4
15th april - 64.1
16th April -63.7
[16/04, 08:30]cm: I think it's not due to hyperthyroidism but due to your diligent life style changes to actively reduce weight that's responsible.
That report of biochemical hyperthyroidism is likely to be an incidentaloma (a product of our over-testing and overtreatment pandemic)
[16/04, 08:43]patient 38F
: I have stress, doc also said it could be because I stopped tryptomer.
[16/04, 08:45]cm: That's more likely! Agree with that hypothesis
(16/04, 08:43) patient 38F: My primary Doc says get a thyroid scan and see an endocrinologist.
[18/04, 08:33]cm: She's a maximalist over tester (which is the current norm)!
A decade ago, in Your Medical Mind: How to Decide What is Right for You, Harvard doctors Jerome Groopman and Pamela Hartzband broadly divided people into medical “maximalists” and “minimalists.” Maximalists are more likely to go to the doctor, willingly take medication, and undergo invasive testing. Minimalists take more of a wait-and-see approach; they prefer to seek cures in diet and exercise.
https://www.health.harvard.edu/blog/whats-your-approach-to-health-check-your-medicine-cabinet-2021021621936
[18/04, 08:51] Patient 38F: Anyway have to go to endocrinologist right, will follow what they say. Any dr names u have?
[19/04, 07:48] Patient 38F : U saw this prescription from the endocrinologist for methimazole 10 mg? The doc was very jovial and fun..:)
[19/04, 07:57]cm: Saw it and realised I sent the patient to a maximalist(but that's the norm anyway so I should have known better)!
As a minimalist I may not have started treatment for myself (for the patient I let them make their own decisions after I share with them the data as I have quoted here below) irrespective of the fact that it's recommended as a treatment in this scenario by endocrinologists globally and the current data that holds me back to start treatment for my own self (not my patients) is:
"Subclinical hyperthyroidism progresses to overt hyperthyroidism in a minority of patients. One prospective study found that only 3% of women older than 60 years with subclinical hyperthyroidism and an initial TSH level of 0.1 to 0.4 mIU per L progressed to overt hyperthyroidism over a median follow-up of 41 months.12 In comparison, 27% of women with TSH levels less than 0.1 mIU per L progressed to overt hyperthyroidism over two years."
https://www.aafp.org/pubs/afp/issues/2017/0601/p710.html
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