32-year-old female, comes into your office with complaints of “feeling tired” and “hair falling out”. She has gained 30 pounds in the last year but notes markedly decreased appetite. On ROS, she reports not sleeping well and feels cold all the time. She is still able to enjoy her hobbies and does not believe that she is depressed.

Introduction:
The presented case involves a 32-year-old female who complains of fatigue, hair loss, weight gain, decreased appetite, sleeping problems, and feeling cold. These symptoms can be indicative of an underlying medical condition, and further investigation is necessary to determine the cause. This paper aims to analyze the symptoms and recommend potential diagnoses based on a comprehensive understanding of the patient’s history, physical examination findings, and additional laboratory tests.

Evaluation of Symptoms:
Fatigue: Fatigue is a common complaint and can have multiple etiologies. It can be caused by psychological factors such as depression or anxiety, chronic diseases like anemia or chronic fatigue syndrome, and endocrine disorders including hypothyroidism or adrenal insufficiency. In this case, the patient denies feelings of depression, suggesting that psychological factors may not be the primary cause of fatigue.
Hair Loss: Hair loss can be a distressing symptom and can result from various factors. It can occur due to hormonal imbalances, nutritional deficiencies, autoimmune diseases like alopecia areata, or as a side effect of certain medications. The presence of hair loss further supports the need for a thorough evaluation in this particular case.
Weight Gain: The patient’s weight gain of 30 pounds in the past year, despite a decreased appetite, raises concerns about possible metabolic or endocrine dysfunctions. It is crucial to assess the patient’s dietary habits, physical activity levels, and conduct a detailed medical history to rule out potential causes like Cushing’s syndrome, polycystic ovary syndrome (PCOS), or hypothyroidism.
Decreased Appetite: Although the patient reports a decreased appetite, the substantial weight gain suggests an underlying hormonal or metabolic disturbance rather than a simple reduction in caloric intake. Conditions such as hyperthyroidism or malabsorption disorders should be considered in the differential diagnosis.
Sleeping Problems: The patient complains of poor sleep quality. Sleep disturbances can be associated with various medical conditions, including hyperthyroidism, depression, anxiety disorders, or obstructive sleep apnea. Further evaluation is necessary to determine the cause of the patient’s sleeping difficulties.
Feeling Cold: The patient describes feeling cold all the time, which can be indicative of an abnormality in thermoregulation. Hypothyroidism, an endocrine disorder, is one of the most common causes of sensitivity to cold due to its effect on slowing down metabolic processes. Additional causes for feeling cold could be poor circulation, anemia, or other endocrine disorders such as Addison’s disease.

Differential Diagnosis:
Based on the patient’s symptoms, the following are potential differential diagnoses to consider:

1. Hypothyroidism: This endocrine disorder is characterized by low levels of thyroid hormone and can cause fatigue, weight gain, hair loss, cold intolerance, and sleeping problems. To confirm or rule out this condition, thyroid function tests should be ordered, including TSH (thyroid-stimulating hormone), free T4 (thyroxine), and possibly free T3 (triiodothyronine) levels.

2. Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder commonly associated with weight gain, irregular menstrual cycles, and hair loss. Additional symptoms may include acne and increased facial hair growth. Blood tests to assess hormone levels, such as luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone, can aid in the diagnosis.

3. Cushing’s Syndrome: This condition occurs due to excessive exposure to cortisol, a hormone produced by the adrenal glands. It can cause weight gain, especially in the face and abdomen, hair loss, and decreased appetite. Laboratory tests including measuring cortisol levels, dexamethasone suppression test, and imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI) of the adrenal glands may be necessary for diagnosis.

4. Anemia: Anemia, specifically iron deficiency anemia, can lead to fatigue, hair loss, and feeling cold. A complete blood count (CBC) and iron studies, including ferritin, should be performed to assess the patient’s iron levels.

Conclusion:
Given the patient’s symptoms of fatigue, hair loss, weight gain, decreased appetite, sleeping problems, and feeling cold, a thorough evaluation must be conducted to determine the underlying cause. Potential differential diagnoses include hypothyroidism, PCOS, Cushing’s syndrome, and anemia. Additional laboratory tests, including thyroid function tests, hormone assessments, and iron studies, should be performed to aid in the diagnosis.