Differential Diagnosis
- Single most likely diagnosis
- Thyroid suppression due to amiodarone: The patient's symptoms of worsening depression, lethargy, chills, hair loss, constipation, and dry skin are consistent with hypothyroidism, a known side effect of amiodarone. The physical examination finding of +1/4 patellar reflexes bilaterally also supports this diagnosis, as hypothyroidism can cause delayed relaxation of deep tendon reflexes.
- Other Likely diagnoses
- Idiopathic major depressive disorder: The patient's symptoms of depression and lethargy could be attributed to a major depressive disorder, which is a common condition in the general population.
- Uncontrolled type 2 diabetes: Poorly controlled diabetes can cause a range of symptoms, including lethargy, hair loss, and constipation, although the presence of chills and dry skin is less typical.
- Electrolyte imbalance due to furosemide: Furosemide can cause electrolyte imbalances, particularly hypokalemia, which can lead to muscle weakness, fatigue, and constipation. However, the patient's symptoms are more suggestive of a metabolic or endocrine disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Myxedema coma: Although less likely, myxedema coma is a life-threatening condition that can occur in patients with severe, untreated hypothyroidism. The patient's symptoms of lethargy, chills, and dry skin could be indicative of this condition, and it is essential to consider it in the differential diagnosis.
- Adrenal insufficiency: The patient's symptoms of lethargy, hair loss, and constipation could also be suggestive of adrenal insufficiency, which can be caused by a variety of factors, including medication side effects or underlying adrenal disease.
- Rare diagnoses
- Pituitary or adrenal tumors: Although rare, pituitary or adrenal tumors can cause a range of symptoms, including depression, lethargy, and hair loss. These conditions would require further evaluation and testing to diagnose.
- Autoimmune polyendocrine syndrome: This rare condition is characterized by the presence of multiple endocrine disorders, including hypothyroidism, and could be considered in the differential diagnosis if the patient's symptoms are not fully explained by a single condition.