SEVERE REFRACTORY HYPOTHYROIDISM IN A 48-YEAR-OLD FEMALE: ROLE OF LOW-DOSE
THYROXINE ABSORPTION TEST IN ESTABLISHING DIAGNOSIS OF NONCOMPLIANCE
, Alternate Version – August 2026
Encounter Date: August 19, 2026
Setting: Community Health Center – Primary Care
Provider: [Your Name], DO
Case ID: IH-2026-0819-HT48F-ALT
I. Patient Identification & Chief Complaint
Name: Ms. Diane Chen
Age: 48 years
Sex: Female
Race/Ethnicity: Asian American (Chinese descent)
Occupation: Accountant (CPA), works remotely
Marital Status: Divorced, one son (age 17, lives with father)
Chief Complaint:
“I can’t keep up with my work anymore. I’m exhausted, my face looks puffy, and I’ve gained 18
pounds even though I eat less.”
II. History of Present Illness (HPI)
Ms. Chen is a 48-year-old female presenting with a 10-month history of progressive fatigue,
weight gain, and cognitive decline. She reports:
• Fatigue: Severe, constant; rates 8/10. Falls asleep at desk by 2 PM daily. Requires 2–3
naps on weekends.
• Weight gain: +18 lbs (8.2 kg) over 10 months despite reduced caloric intake and
intermittent fasting (16:8). BMI increased from 24.3 to 27.6.
• Cold intolerance: Keeps thermostat at 76°F (24.5°C); wears fleece vest indoors year-
round.
• Cognitive dysfunction: “Mental fog” affecting work accuracy—missed quarterly filing
deadline first time in 20-year career. Forgets client names, repeats emails.
• Constipation: Bowel movements every 4–5 days; uses magnesium citrate 1–2×/week.
• Mood: Depressed, tearful during interview. PHQ-9 = 11 (moderate depression). Denies
SI/HI.
THYROXINE ABSORPTION TEST IN ESTABLISHING DIAGNOSIS OF NONCOMPLIANCE
, Alternate Version – August 2026
Encounter Date: August 19, 2026
Setting: Community Health Center – Primary Care
Provider: [Your Name], DO
Case ID: IH-2026-0819-HT48F-ALT
I. Patient Identification & Chief Complaint
Name: Ms. Diane Chen
Age: 48 years
Sex: Female
Race/Ethnicity: Asian American (Chinese descent)
Occupation: Accountant (CPA), works remotely
Marital Status: Divorced, one son (age 17, lives with father)
Chief Complaint:
“I can’t keep up with my work anymore. I’m exhausted, my face looks puffy, and I’ve gained 18
pounds even though I eat less.”
II. History of Present Illness (HPI)
Ms. Chen is a 48-year-old female presenting with a 10-month history of progressive fatigue,
weight gain, and cognitive decline. She reports:
• Fatigue: Severe, constant; rates 8/10. Falls asleep at desk by 2 PM daily. Requires 2–3
naps on weekends.
• Weight gain: +18 lbs (8.2 kg) over 10 months despite reduced caloric intake and
intermittent fasting (16:8). BMI increased from 24.3 to 27.6.
• Cold intolerance: Keeps thermostat at 76°F (24.5°C); wears fleece vest indoors year-
round.
• Cognitive dysfunction: “Mental fog” affecting work accuracy—missed quarterly filing
deadline first time in 20-year career. Forgets client names, repeats emails.
• Constipation: Bowel movements every 4–5 days; uses magnesium citrate 1–2×/week.
• Mood: Depressed, tearful during interview. PHQ-9 = 11 (moderate depression). Denies
SI/HI.
