Case Report Template 2017: Difference between revisions

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== Hashimoto’s Thyroiditis Case Study<br> ==
== Title  ==


== Keywords&nbsp; ==
== Keywords ==
 
Hashimoto’s thyroiditis, autoimmune disease


== 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>
add names of all authors here


== 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>
100 word limit, non-structured description
 
<br>
 
==


== 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">https://ghr.nlm.nih.gov/condition/hashimoto-thyroiditis#statistics</ref>&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>
The introduction is where we a clear idea of what is particularly interesting about the case we want to describe.  


== 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.  
This is the part of the paper in which we introduce the raw data. First, we describe the complaint that brought the patient to us. It is often useful to use the patient’s own words.&nbsp;Next, we introduce the important information that we obtained from our history-taking.


-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>
*Subjective&nbsp;: Patient History and Systems Review (chief complaints, other relevant medical history, prior or current services related to the current episode, use relative dates i.e. years or months or days relative to onset of injury or start of treatment, patient/family goals)
*Demographic Information: (occupation/vocation, gender, age, etc.)
*Medical diagnosis if applicable
*Co-morbidities
*Previous care or treatment
*Self Report Outcome Measures
*Physical Performance Measures
*Objective&nbsp;: Physical Examination Tests and Measures


== 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
 
<br>


== Intervention  ==
== Intervention  ==


Discussed POC with patient 2x week for 4 weeks<br>Patient education regarding posture and sleeping mechanics<br>Postural retraining of the cervical spine<br>Ergonomic training<br>Strengthening exercises of trunk and postural back muscles<br>Postural stability training of the postural back muscles<br>Core stabilization exercises<br>Stretching exercises for the wrist and hands<br>Nerve tendon gliding of the median nerve<br>Thoracic mobilization to increase cervical ROM<br><br>
*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  ==
== Outcomes  ==
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== Discussion  ==
== Discussion  ==


There is limited research on physical therapy to treat Hashimoto’s thyroiditis, however<br>Physical therapists are able to treat the musculoskeletal impairments secondary to the disease. Recent studies show it is not uncommon for persons with hypothyroidism to have carpal tunnel syndrome<ref name="Karne">Karne SS, Bhalero NS. Carpal Tunnel Syndrome in Hypothyroidism. (internet).          Journal of clinical and diagnostic research : JCDR. U.S. National Library of Medicine; 2016 (cited 2017Mar24). Available from: https//:www.ncbi.nlm.nih.gov/pubmed/27042500</ref>among other musculoskeletal impairments. Physical therapist discretion must be used and thorough differential diagnosis must be performed in order to carefully screen for rheumatic and certain neurological diseases which are a contraindication for manipulation. More research must be performed in the area of how physical therapy can assist patients who are experiencing musculoskeletal impairments secondary to hypothyroid dysfunction.<br><br>
Summary Statement which should include related findings in the literature, potential impact on clinical practices


== Acknowledgements ==
== Acknowledgements ==
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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<br> ==
== Related Pages ==


[http://emedicine.medscape.com/article/120937-overview Medscape]<br>[https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease National Institute of Health]<br>
add links to related Physiopedia pages here


== References  ==
== References  ==

Revision as of 11:30, 27 March 2017

Title[edit | edit source]

Keywords[edit | edit source]

Word count[edit | edit source]

word count <2000 words

Author/s[edit | edit source]

add names of all authors here

Abstract[edit | edit source]

100 word limit, non-structured description

Introduction[edit | edit source]

The introduction is where we a clear idea of what is particularly interesting about the case we want to describe.

Case Presentation[edit | edit source]

This is the part of the paper in which we introduce the raw data. First, we describe the complaint that brought the patient to us. It is often useful to use the patient’s own words. Next, we introduce the important information that we obtained from our history-taking.

  • Subjective : Patient History and Systems Review (chief complaints, other relevant medical history, prior or current services related to the current episode, use relative dates i.e. years or months or days relative to onset of injury or start of treatment, patient/family goals)
  • Demographic Information: (occupation/vocation, gender, age, etc.)
  • Medical diagnosis if applicable
  • Co-morbidities
  • Previous care or treatment
  • Self Report Outcome Measures
  • Physical Performance Measures
  • Objective : Physical Examination Tests and Measures

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]

add links to related Physiopedia pages here

References[edit | edit source]

References will automatically be added here, see adding references tutorial.