| Provisional Diagnosis | - | ITP
?Thrombocytopenia secondary to Hypersplenism
Thyroid nodule evaluation to r/o malignancy
Work up for inherited thrombophilia
| |
| Final Diagnosis | - | Extra hepatic portal vein obstruction(EHPVO)
Portal hypertension & Hypersplenism
Papillary carcinima thyroid(S/p Total thyroidectomy)
Vit D Def
Neurasthenia | |
| History and Findings | - | Referred by Dr.Pavithran Prof Med oncology
A k/c/o ITP on management from CMC Vellore(age 17-27) & from TVM MCH by Dr.Pavithran from age 27 onwards.Off steroids since 2004 h/o Gen Oedema/polyarthritis/Polymyalgia/DOE class II,snoring,sllep apnoea,recurrent throat infection x 4yrs.Past H/o B/l renal calculi & obstructive hydroureteronephrosis in 2006.Ureterolithotomy Rt on 25/08/06
Wt-104kg BMI-37.3,Thyroid nodule Lt lobe+
| |
| Investigation | - | Hb-12.8,ESR-28,plat-150.0,uric-5.9,HBA!c-5.3,LFT N
25(OH)vit D -14.18,IgE-147,TSH-2.03,ATg-0.82,TPO-0.30,ANA-Neg,ACE-53(N),Cortisol-10.1,CA-125-12,CEA-1.94,APLA IgM,IgG-N,AFP-3.38,CA 19-9-21.48,Beta HCG <1.20,PT with INR APTT-n,Thrombophilia work up normal,MDCT abd contrast 04/04/11-Liver volume redistribution with hypertrophy of caudate lobe,no IHBRD,few nodules s/o hemangioma,splenic & portal vein not visualised.Splenic artery aneurysm & multiple spleno renal collaterals,splenomegaly 15mm s/o extrahepatic portal vein obstruction & PHTN
OGD scopy 06/04/110-No varices severe Portal hypertensive gastropathy.FNAC Thyroid Lt Lobe 06/04/11-S/o Papillary carcinoma
Total thyroidectomy done on 28/04/11(HNS dept).HPR Papillary thyroid carcinoma Lt lobe,no nodes identified | |
| Treatment | - | On I 131 therapy followed by oral LT4
Oral calcium & calcirol,Zosert,Evion,Razo D | |
| Follow Up | - | Pt doing well on treatment | |
Saji Elizabeth Jacob,49yrs/F 30/03/11
doctor bhaskaaran
wkfvcepdupscibtlbsbo, http://www.lmyhjkaety.com iaroburchp
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