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Saji Elizabeth Jacob,49yrs/F 30/03/11

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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
doctor bhaskaaran

doctor bhaskaaran

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