AB.4. Vignana Jyothi - Mrs Maria John
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Dr Patric Dsouza
Senior Endocrinologist
Blue Well Hospital
Australia
468 St kilda Rd
Melbourne
VIC 3004
14 December 2014
Dear Dr Dsouza
Re: Mrs Maria John, aged 60
Thank you for seeing Mrs Maria John, who manifested symptoms of hyperthyroidism requires proficient assessment and management following discharge today.
Mrs John, who was presented on 11 December 2014 with slurred speech and polydipsia, not only had dry mouth, dizziness, abdominal pain due to constipation, irritable bowel syndrome in addition to hernia repair with blood transfusion in 2010 along with joint pain due to osteoarthritis since 2011 on assessment, but also had weight loss, hair loss, sweating, increased fatigue, insomnia, irritability since May 2014, which remarkably confirms symptoms of hyperthyroidism. On analysing, BP was relatively high (170/110 mm of hg) beside which labs revealed depleted TSH and hemoglobin along with elevated T3, T4 and blood glucose. Radiology's projected enlarged glands in the neck, minimal bleeding in temporal lobe and slight bulging in the right upper quadrant of the abdomen. Though investigations are directing to thyroidectomy Mrs John prefers medical management.
Mrs John lives with her husband with venture of right hemeplegia as a consequence of hypertension along with seizure disorder and osteoporosis. For the afore-mentioned interpretations conservative ongoing management was with tablet rampril 5mg daily, thyroxine 25mg twice daily, insulin injection, calcium supplements, NSAIDS, paracetamol 500mg twice a day, pantoprozole 40 mg once a day.
It would be highly appreciated if medication compliance with dietary modification for calcium correction if which also includes high fibre, restricted salt and limiting dairy products are followed as recommended. Views on physiotherapy and regular exercises like walking after meals would be extreemely beneficial. A scheduled appointment is fixed after 2 weeks with TSH reports are to be supervised.
Incase of any additional information required, please do not hesitate to contact me.
Yours sincerely
Ms Shelly Kate
Charge Nurse
Blue Well Hospital.
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