Differential Diagnosis
The patient presents with heavy menstrual bleeding, irregular periods, and a history of medical and surgical conditions. The following differential diagnoses are considered:
- Single most likely diagnosis
- Uterine Fibroids: The patient's symptoms of heavy menstrual bleeding, large clots, and irregular periods are consistent with uterine fibroids. The presence of a copper IUD, which can sometimes cause heavy bleeding, may also be a contributing factor.
- Other Likely diagnoses
- Hormonal Imbalance: The patient's history of hyperthyroidism and recent hemithyroidectomy may be contributing to hormonal imbalances, leading to irregular periods and heavy bleeding.
- Adenomyosis: The patient's symptoms of heavy menstrual bleeding, large clots, and irregular periods are also consistent with adenomyosis, a condition where tissue similar to the lining of the uterus grows into the uterine wall.
- Copper IUD-related complications: The patient's copper IUD, which is due for replacement, may be causing or contributing to the heavy bleeding and irregular periods.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Uterine Cancer: Although less likely, uterine cancer must be considered in the differential diagnosis, especially given the patient's postmenopausal age and symptoms of heavy bleeding and irregular periods.
- Bleeding Disorders: Bleeding disorders, such as von Willebrand disease, may be contributing to the patient's heavy menstrual bleeding and must be considered in the differential diagnosis.
- Rare diagnoses
- Uterine Arteriovenous Malformation (AVM): A rare condition where there is an abnormal connection between the arteries and veins in the uterus, which can cause heavy bleeding.
- Uterine Sarcoma: A rare type of cancer that can cause heavy bleeding and irregular periods.
Each of these diagnoses requires further evaluation and investigation to determine the underlying cause of the patient's symptoms.