AC.15. Satya Lakshmi - Mrs Maria John

---

Dr Patric D'Souza

Senior Endocrinologist

Blue Well Hospital

Australia

468 St Kilda Road

Melbourne

VIC 3004

14 December 2014

Dear Dr Dsauza

Re: Mrs Maria John, aged 60

Mrs Mrs John, who has been exhibiting exacerbated signs and symptoms of hyperthyroidism, requires expert assessment and treatment from your facility following discharge.

On 11 December 2014, Mrs John was admitted with complains of dizziness, slurred speech and irritability along with pain in joints and abdomen. Additionally, dry mouth, fatigue and polydypsia were observed. On examination, blood pressure significantly high with 170/100mmofHg. Laboratory results revealed decreased TSH with increased T3, T4, hemoglobin 8mg/do and blood glucose levels about 400mg/dl. Radiological examination showed mild haemorrhage in temporal lobe, swelling in right upper quadrant of abdomen and inflammation of glands in neck.

During hospitalization, Mrs John has been managed with conservative treatment. The list of the medication are enclosed with this letter for your reference. She prefers medical management inspite of suggestive thyroidectomy.

Mrs John lives with husband in a rented flat. She has had hypertension, stroke with right side paralysis and seizures disorder. Also, she has been treated for Osteoporosis since 2011.

Upon discharge, compliance of medication and dietary modifications such as high fiber, less dairy products and salt restricted diet are recommended. Physiotherapy and regular exercises including walking after meals are adviced. A review with the senior Endocrinologist with TSH report after two weeks has been scheduled.

If any additional information is required, please do not hesitate to contact me.

Yours sincerely

Shelly Katte

Charge Nurse

Blue Well Hospital

---