08-03-2011, 04:12 PM
Presented by:
Dr. K. Sowmya
[attachment=9805]
A CASE OF HYPOTHYROIDISM WITH DELAYED PUBERTY AND PUBERTY MENORRHAGIA
Present complaint started 15 days back as heavy periods associated with clots wetting 4-5 diapers / day and continued till now.
The bleeding is not associated with pain.
H/o. cold intolerance
H/o. constipation
There is h/o. 4 months amenorrhea before the starting of bleeding.
No h/o. similar complaint previously.
No h/o injury. No h/o fever.
No h/o spontaneous or induced abortion
No h/o D & C
No h/o steroid therapy for any reason
No h/o bleeding disorder in the past or in the family
No h/o administration of anticoagulants for any reason.
Gynaec h/o
Attained menarchy at the age of 24 years i.e., 1 year back.
Menstrual history – bleeding for 4-5 days wetting 3-4 diapers / day, heavy flow, associated with clots every 2-3 months and not associated with pain.
LMP - 15 days
Past h/o
There is no h/o similer complaint previously
No h/o bleeding disorder
No h/o TB, Asthma
No h/o drug allergy
No previous h/o blood transfusion
Personal h/o
She takes mixed diet
Sleep & apetite – normal
Intelligence - normal
Studied upto – 10th class
h/o constipation - present
Family h/o
Sibling history
She is the youngest girl of 4 sisters, all the other 3 girls and parents are normal.
No h/o similar complaint in her siblings.
No h/o genetic disorders in family.
No h/o consaguinous marriage of her parents.
No h/o bleeding disorders.
No h/o HTN, DM
General examination
She is short statured with height 123 cm & wt. 38 kg.
Moderately nourished
Secondary sexual characters are not well developed – Tanner B2 PH1 stage
- No axillary hair
Coarse facial features s/o hypothyroidism
Dry mottled skin
Coarse facial features
Broad flat nose
Puffy face
There is no lymphadnopathy
Brests – B2 tanner stag.
Thyroid – No goitre
Severe anaemia
No jaundice
No oedema feet
No clubbing
No cyanosis
Vital parameters
Temp – Normal
PR : 72/mt, regular, low volume.
BP : 80 / 50 mm hg
RR : 24/mt
Systemic examination
Cvs S1+ S2+, no added sounds
Resp. system : clear
Bilateral air entry normal
Gynecological examination
Abdomen :
Inspection :
Skin over the abdomen – normal
No visible or engorged veins
There are no scars
Umbilicus – normal, not everted
All quadrants are moving equally with respiration
All hernial orifices are normal.
Palpation
No tenderness
No rigidity, No gaurding
No palpable lumps
Pelvic examination :
External genitalia – infantile
Pubic hair PH1 stage
Bleeding p/v present
Investigations
Complete Haemogram
HB % = 3.8 gm %
TRBC = 0.50 milions / cumm
TWBC = 8,600 / cumm
DC = P-75%, L – 21% E – 04%
ESR = 20 mm / 1st hr
Platelet count = 1,02,000 /cumm
PCV = 4 ml %
BT = 2’ 50”
CT = 5’ 20”
Peripheral Smear
RBC – microcytic, hypochromic RBC with anisocysosis, occasional target cells.
WBC – TC, DC with in normal limits.
No abnormal cells.
Platelets – around lower normal range seen diserete
No haemoparasites
Impression : microcytic, hypochromic anaemia. Correlate clinical
Blood group & Rh type : A+ve
RBS – 102 mg / dl
Blood urea – 36 mg / dl
Serum creatinine - 1.3 mg / dl
HBs Ag – Negative
HIV – Non reactive
Thyroid profile
T 3 - 0.29 ng / dl
T 4 - 1.04 µg / dl
TSH - 200 mU / Lt
FSH
LH
Oestrogen
Prolactin
Testosterone
CT Scan
MRI Scan
Buccal smear
Karyotyping
USG
Uterus : 8 cm x 4 cm x 3 cm
Endometrium – Collection noted in uterus more in lower uterine segment and external os region and vagina
Rt ovary not visualised
Lt ovary normal
Diagnosis
Hypothroidism with delayed puberty & puberty menorrhagia
Treatment given
5 units of blood transfusion done
Tab Eltroxin 100 µg / day
Progesterone (Regesterone) started at 25 mg/day as 5 mg 5 times a day and tapered to 5 mg Od in 5 days and advised to continue it for 20 days.
Advised review after one week - no follow up.
Dr. K. Sowmya
[attachment=9805]
A CASE OF HYPOTHYROIDISM WITH DELAYED PUBERTY AND PUBERTY MENORRHAGIA
Present complaint started 15 days back as heavy periods associated with clots wetting 4-5 diapers / day and continued till now.
The bleeding is not associated with pain.
H/o. cold intolerance
H/o. constipation
There is h/o. 4 months amenorrhea before the starting of bleeding.
No h/o. similar complaint previously.
No h/o injury. No h/o fever.
No h/o spontaneous or induced abortion
No h/o D & C
No h/o steroid therapy for any reason
No h/o bleeding disorder in the past or in the family
No h/o administration of anticoagulants for any reason.
Gynaec h/o
Attained menarchy at the age of 24 years i.e., 1 year back.
Menstrual history – bleeding for 4-5 days wetting 3-4 diapers / day, heavy flow, associated with clots every 2-3 months and not associated with pain.
LMP - 15 days
Past h/o
There is no h/o similer complaint previously
No h/o bleeding disorder
No h/o TB, Asthma
No h/o drug allergy
No previous h/o blood transfusion
Personal h/o
She takes mixed diet
Sleep & apetite – normal
Intelligence - normal
Studied upto – 10th class
h/o constipation - present
Family h/o
Sibling history
She is the youngest girl of 4 sisters, all the other 3 girls and parents are normal.
No h/o similar complaint in her siblings.
No h/o genetic disorders in family.
No h/o consaguinous marriage of her parents.
No h/o bleeding disorders.
No h/o HTN, DM
General examination
She is short statured with height 123 cm & wt. 38 kg.
Moderately nourished
Secondary sexual characters are not well developed – Tanner B2 PH1 stage
- No axillary hair
Coarse facial features s/o hypothyroidism
Dry mottled skin
Coarse facial features
Broad flat nose
Puffy face
There is no lymphadnopathy
Brests – B2 tanner stag.
Thyroid – No goitre
Severe anaemia
No jaundice
No oedema feet
No clubbing
No cyanosis
Vital parameters
Temp – Normal
PR : 72/mt, regular, low volume.
BP : 80 / 50 mm hg
RR : 24/mt
Systemic examination
Cvs S1+ S2+, no added sounds
Resp. system : clear
Bilateral air entry normal
Gynecological examination
Abdomen :
Inspection :
Skin over the abdomen – normal
No visible or engorged veins
There are no scars
Umbilicus – normal, not everted
All quadrants are moving equally with respiration
All hernial orifices are normal.
Palpation
No tenderness
No rigidity, No gaurding
No palpable lumps
Pelvic examination :
External genitalia – infantile
Pubic hair PH1 stage
Bleeding p/v present
Investigations
Complete Haemogram
HB % = 3.8 gm %
TRBC = 0.50 milions / cumm
TWBC = 8,600 / cumm
DC = P-75%, L – 21% E – 04%
ESR = 20 mm / 1st hr
Platelet count = 1,02,000 /cumm
PCV = 4 ml %
BT = 2’ 50”
CT = 5’ 20”
Peripheral Smear
RBC – microcytic, hypochromic RBC with anisocysosis, occasional target cells.
WBC – TC, DC with in normal limits.
No abnormal cells.
Platelets – around lower normal range seen diserete
No haemoparasites
Impression : microcytic, hypochromic anaemia. Correlate clinical
Blood group & Rh type : A+ve
RBS – 102 mg / dl
Blood urea – 36 mg / dl
Serum creatinine - 1.3 mg / dl
HBs Ag – Negative
HIV – Non reactive
Thyroid profile
T 3 - 0.29 ng / dl
T 4 - 1.04 µg / dl
TSH - 200 mU / Lt
FSH
LH
Oestrogen
Prolactin
Testosterone
CT Scan
MRI Scan
Buccal smear
Karyotyping
USG
Uterus : 8 cm x 4 cm x 3 cm
Endometrium – Collection noted in uterus more in lower uterine segment and external os region and vagina
Rt ovary not visualised
Lt ovary normal
Diagnosis
Hypothroidism with delayed puberty & puberty menorrhagia
Treatment given
5 units of blood transfusion done
Tab Eltroxin 100 µg / day
Progesterone (Regesterone) started at 25 mg/day as 5 mg 5 times a day and tapered to 5 mg Od in 5 days and advised to continue it for 20 days.
Advised review after one week - no follow up.