Chronic Illness

A 28 year old female presents for complaints of fatigue, increased sleeping, and weight gain. She states she has had depression off and on since she was 17.  She denies any other health problems and has never taken any prescription medication, including anything for depression.

What are your differentials? What laboratory tests could you perform? How would be your treatment plan?

Answers:

Differential diagnoses for the symptoms described could include:

  1. Major depressive disorder: Given the patient’s history of depression and current symptoms, a diagnosis of major depressive disorder should be considered and ruled out first.
  2. Hypothyroidism: Symptoms such as fatigue, increased sleeping, and weight gain are commonly seen in hypothyroidism and should be ruled out.
  3. Sleep Apnea: Excessive daytime sleepiness and weight gain are common symptoms of sleep apnea, and this should also be considered.
  4. Chronic fatigue syndrome: This condition can present with persistent fatigue and sleep disturbance and should be considered as a differential.
  5. Substance abuse: Substance abuse, particularly of sedatives or opioids, can also cause fatigue and excessive sleepiness, and this should be ruled out.

Laboratory tests that could be performed to help diagnose the underlying condition include:

  1. Thyroid-stimulating hormone (TSH) levels: To rule out hypothyroidism.
  2. Complete Blood Count (CBC): To rule out anemia or other blood disorders that may cause fatigue.
  3. Serum electrolyte levels: To rule out electrolyte imbalances that may cause fatigue.
  4. Sedimentation rate and C-reactive protein: To rule out inflammation or infection as a cause of fatigue.
  5. Drug screening: To rule out substance abuse.

Treatment plan:

  1. Major depressive disorder: If a diagnosis of major depressive disorder is confirmed, the first-line treatment would typically be an antidepressant medication and/or psychotherapy.
  2. Hypothyroidism: If hypothyroidism is diagnosed, the patient will need to be started on levothyroxine therapy.
  3. Sleep apnea: If sleep apnea is suspected, a referral for a sleep study may be necessary. Treatment could involve lifestyle changes, such as weight loss and avoiding alcohol, as well as continuous positive airway pressure (CPAP) therapy.
  4. Chronic fatigue syndrome: Treatment for this condition may include a combination of medications, such as anti-inflammatory drugs, and behavioral therapy to help manage symptoms.
  5. Substance abuse: If substance abuse is suspected, referral to a substance abuse specialist is recommended for further evaluation and treatment.

It’s important to note that the above information is not intended to be a substitute for a thorough clinical evaluation and diagnosis by a healthcare professional.

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