Case Report Template 2017: Difference between revisions

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== Hashimoto’s Thyroiditis Case Study<br> ==
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== Keywords&nbsp; ==
== Keywords ==


Hashimoto’s thyroiditis, autoimmune disease
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== Word count  ==
== Word count  ==
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word count &lt;2000 words  
word count &lt;2000 words  


== Author/s<br> ==
== Author/s ==


Tori Kute <br>Kerri Falk<br>
<br>  


== Abstract  ==
== Abstract  ==
Hashimoto’s thyroiditis is an autoimmune disease. Hashimoto’s thyroiditis is often associated with arthralgia, myalgia, can lead to myopathy. Physical therapy can assist with the neuromuscular and musculoskeletal materializations that are seen in many patients with the condition.<ref name="Medscape">http://emedicine.medscape.com/article/120937-overview  accessed 3/21/17</ref>&nbsp;Physical therapy emphasis is on restoring the secondary effects of the disease such as restoration of joint range of motion, alleviation of pain in joints and muscles, and restoring strength due to muscle weakness. This case study depicts what may be seen in a patient coming to Physical therapy with Hashimoto’s thyroiditis as well as clinical impression, interventions, and outcomes. <br>


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== Introduction  ==
== Introduction  ==


Hashimoto’s thyroiditis was first discovered in 1912 by Japanese physician Hakaru Hashimoto (1881−1934). Hashimoto's thyroiditis or chronic lymphocytic thyroiditis is an organ specific autoimmune disease in which the thyroid gland is attacked by cell and antibody mediated responses.<ref name="Medscape" />&nbsp;Hashimoto’s is the most common cause of hypothyroidism in the United States.<ref name="NIH" />&nbsp;Incidence is estimated to be 3.5 per 1000 per year in women and 0.8 per 1000 per year in men, or 1-2% of the population.<ref name="NIH" />&nbsp;The disease slowly can progress over time into thyroid deficiency. Musculoskeletal and neuromuscular manifestations can occur at any time during the disease process.<ref name="Medscape" />&nbsp;According to a study by Cakir M, Samanci N, Balci N, Balci MK adhesive capsulitis, Dupuytren’s contracture, trigger finger, limited joint mobility and carpal tunnel syndrome have all been found in patients with hypothyroidism.<ref name="Cakir">Cakir M, Samanci N, Balci N, Balci MK. Musculoskeletal manifestations in patients with thyroid disease. Clinical Endocrinology. 2003;59(2):162-7</ref>&nbsp;<br>
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== Case Presentation  ==
== Case Presentation  ==
Susan is a 46 year old elementary school teacher. She reports that she has been feeling more fatigued over the last couple of months compared to previously. She attributed it to beginning a new school year. Susan complains of feeling overall muscle aches and stiffness especially at her neck during that time that was not progressed or lessened. It has not been relieved with ibuprofen or heat. Patient has a tender palpable mass on the anterior aspect of her neck. Personal and familial history of hypothyroidism. Cervical and thoracic ROM limited in several directions.
-Medical diagnosis: hypothyroidism 3 years prior <br>-Co-morbidities: hypertension, Type 2 diabetes mellitus<br>-Past medical history: ACL reconstruction when she was twenty. <br>-Family medical history: grandmother had hypothyroidism. Father had an MI at approximately 55 years old. <br>-Medications/supplements: lisinopril (anti-hypertensive); multi-vitamin, synthroid<br>-Previous physical therapy treatment: Following ACL reconstruction approximately twenty years ago. Treatment for adhesive capsulitis 4 years prior. <br>-Self-reported outcomes: Neck Disability Index: 64%; Canadian Occupational Performance Measure unremarkable. <br>-Physical performance outcomes: 5 times sit to stand 11.2 seconds; continuous scale- physical functional performance 63%<br>-Objective: Upon palpation of anterior neck there was the presence of a painful, palpable mass. Upper quarter screen: C4/5 weakness bilaterally. Remaining myotomes and dermatomes were within normal limits. Positive Phalen’s test and positive Tinel’s sign.<br>ROM: Cervical flexion limited to 10 degrees. Cervical extension 35 degrees. Left cervical rotation 26 degrees. Thoracic spine flexion limited to 10 degrees. Side bending bilaterally limited to 15 degrees each side. Remaining upper quarter ROM WNL<br><br>


== Clinical Impression  ==
== Clinical Impression  ==


Increased fatigue<br>Overall muscle aches and stiffness in neck not lessening<br>Palpable tender mass in anterior neck<br>C4/5 weakness bilaterally<br>Cervical flexion limited to 10᠐<br>Cervical extension limited to 35᠐<br>Left cervical rotation limited to 26᠐<br>Thoracic spine flexion 10᠐<br>Bilateral cervical side bending 15᠐<br>NDI 64%<br>Physical function performance 63%<br>Known systemic problem (hypothyroidism)<br>Bilateral Carpal Tunnel Syndrome
Summarization of examination findings,&nbsp;working diagnosis and targeted interventions
 
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== Intervention  ==
== Intervention  ==
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Summary Statement which should include related findings in the literature, potential impact on clinical practices  
Summary Statement which should include related findings in the literature, potential impact on clinical practices  


== Acknowledgements ==
== Acknowledgements ==


If someone provided assistance with the preparation of the case study, we thank them briefly. It is neither necessary nor conventional to thank the patient (although we appreciate what they have taught us). It would generally be regarded as excessive and inappropriate to thank others, such as teachers or colleagues who did not directly participate in preparation of the paper.
If someone provided assistance with the preparation of the case study, we thank them briefly. It is neither necessary nor conventional to thank the patient (although we appreciate what they have taught us). It would generally be regarded as excessive and inappropriate to thank others, such as teachers or colleagues who did not directly participate in preparation of the paper.  


== Related Pages  ==
== Related Pages  ==
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<references />
[[Category:Case Studies]]

Latest revision as of 00:10, 12 March 2018


[edit | edit source]

Keywords[edit | edit source]


Word count[edit | edit source]

word count <2000 words

Author/s[edit | edit source]


Abstract[edit | edit source]


Introduction[edit | edit source]


Case Presentation[edit | edit source]

Clinical Impression[edit | edit source]

Summarization of examination findings, working diagnosis and targeted interventions

Intervention[edit | edit source]

  • Phases of Interventions (e.g. protective phase, mobility phase, etc.)
  • Dosage and Parameters
  • Rationale for Progression
  • Co-interventions if applicable (e.g. injection therapy, medications)

Outcomes[edit | edit source]

Findings Over time

Discussion[edit | edit source]

Summary Statement which should include related findings in the literature, potential impact on clinical practices

Acknowledgements[edit | edit source]

If someone provided assistance with the preparation of the case study, we thank them briefly. It is neither necessary nor conventional to thank the patient (although we appreciate what they have taught us). It would generally be regarded as excessive and inappropriate to thank others, such as teachers or colleagues who did not directly participate in preparation of the paper.

Related Pages[edit | edit source]

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References[edit | edit source]

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