Questions: A 42-year-old man with a history of hyperlipidemia, hypertension, and diabetes mellitus type 2 reports chronic fatigue that has lasted almost an entire year. For the past 8 months, he has had fatigue throughout the day unrelated to sleep or exercise. He also complains of constipation, and he feels that his skin is dry and cold all the time. He also denies suicidal ideations, guilt, psychomotor problems, or other mental health issues. His medications are atorvastatin, metformin, and amlodipine. The patient's temperature is 98.3 degrees Fahrenheit, HR is 80 , RR is 16 , and BP is 140/90. A physical exam reveals cold, clammy skin. What is the most likely cause of his fatigue? A. Depression B. Hypothyroidism C. Systemic lupus erythematosus D. Pituitary insufficiency

A 42-year-old man with a history of hyperlipidemia, hypertension, and diabetes mellitus type 2 reports chronic fatigue that has lasted almost an entire year. For the past 8 months, he has had fatigue throughout the day unrelated to sleep or exercise. He also complains of constipation, and he feels that his skin is dry and cold all the time. He also denies suicidal ideations, guilt, psychomotor problems, or other mental health issues. His medications are atorvastatin, metformin, and amlodipine. The patient's temperature is 98.3 degrees Fahrenheit, HR is 80 , RR is 16 , and BP is 140/90. A physical exam reveals cold, clammy skin. What is the most likely cause of his fatigue?
A. Depression
B. Hypothyroidism
C. Systemic lupus erythematosus
D. Pituitary insufficiency

Transcript text: A 42-year-old man with a history of hyperlipidemia, hypertension, and diabetes mellitus type 2 reports chronic fatigue that has lasted almost an entire year. For the past 8 months, he has had fatigue throughout the day unrelated to sleep or exercise. He also complains of constipation, and he feels that his skin is dry and cold all the time. He also denies suicidal ideations, guilt, psychomotor problems, or other mental health issues. His medications are atorvastatin, metformin, and amlodipine. The patient's temperature is 98.3 degrees Fahrenheit, HR is 80 , RR is 16 , and BP is 140/90. A physical exam reveals cold, clammy skin. What is the most likely cause of his fatigue? A. Depression B. Hypothyroidism C. Systemic lupus erythematosus D. Pituitary insufficiency

Solution

The answer is B: Hypothyroidism.

Explanation for each option:

A. Depression: While depression can cause fatigue, the patient denies any mental health issues such as suicidal ideations, guilt, or psychomotor problems, which are often associated with depression. Additionally, the presence of physical symptoms like constipation and dry, cold skin is more indicative of a physiological condition rather than a psychological one.

B. Hypothyroidism: This condition is characterized by symptoms such as fatigue, constipation, dry and cold skin, and a general slowing of bodily functions. The patient's symptoms align well with hypothyroidism, making it the most likely cause of his fatigue.

C. Systemic lupus erythematosus: This autoimmune disease can cause fatigue, but it typically presents with a variety of other symptoms such as joint pain, skin rashes, and organ involvement, which are not mentioned in this case.

D. Pituitary insufficiency: While this condition can lead to fatigue, it usually presents with a broader range of hormonal deficiencies affecting multiple systems, which would likely cause more diverse symptoms than those described.

In summary, the patient's symptoms are most consistent with hypothyroidism, which explains the chronic fatigue, constipation, and dry, cold skin.

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