Peer Responses:

• Length: A minimum of 180 words per post, not including references
• Citations: At least two high-level scholarly reference in APA per post from within the last 5 years
• Relate/Compare other journal reading.

The first differential diagnosis to consider for this patient would be hypothyroidism (E03.9). Hypothyroidism is a condition in which the thyroid gland severely underproduces thyroid hormone, causing an individual to experience symptoms such as fatigue, weight gain, dry skin, intolerance to cold weather, depression, anxiety and/or lethargy (Jansen et. al., 2023). Diagnostics include checking the thyroid in clinic for enlargement or tenderness and ordering a thyroid panel, with TSH and T4 being checked.

           The second differential diagnosis to consider for this patient would be major depressive disorder (F32.9). Major depressive disorder is a mood disorder that is characterized by the patient experiencing symptoms such as anhedonia, low energy, disturbances in sleep, suicidal thoughts, difficulty concentrating, and depressed mood (Bains & Abdijadid, 2023). Diagnosis is clinical and based on the patient’s HPI and physical exam findings. Testing such as mental status examination and neurologic exam can rule out other conditions.

           The third differential diagnosis to consider for this patient would be polycystic ovarian syndrome (E28.2). PCOS is defined as a disorder of the metabolic and endocrine system which is characterized by irregular menstrual cycles, excess facial and body hair, hair loss, acne, insulin resistance, polycystic ovaries, and infertility (Singh et. al., 2023). Diagnosis is based on three factors: anovulation, hyperandrogenism, and ovarian morphology and the information is obtained by HPI and physical exam findings, a pelvic ultrasound, and bloodwork such as testosterone, LH, and other hormones.

           The final diagnosis for this patient would be hypothyroidism (E03.9). The diagnostics that would be obtained are to check serum TSH, FT3 and FT4 levels. The treatment for this patient is to replace low thyroid levels with Levothyroxine 1.6 ?g/kg/day x 60 days (Jansen et. al., 2023). This patient will continue to take replacement therapy for life. Specific veteran resources that the patient can be referred to include the Bakersfield Vet Center, affiliated with the Veterans Affairs, and is a local center that provides veterans, active members, and families mental health services for depression, PTSD, and military sexual trauma. Another resource is the Bakersfield VA Clinic, affiliated with Veterans affairs, that provides medical and mental health care as well in the form of counseling and medication for conditions such as PTSD. Patient education involves educating the patient on how to take the medication, such as taking on an empty stomach in the morning 1 hour before breakfast for better absorption. Additionally, the patient will be educated that antacids can interact with levothyroxine absorption and should not be taken at or around the same time. The patient will follow up for a blood test in six weeks to recheck TSH levels and see if medication dosages need to be adjusted.