Differential Diagnosis

The patient presents with a range of symptoms following a total laparoscopic hysterectomy, including dizziness, balance issues, hormonal symptoms, chronic headaches, and water retention. The differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Hormonal Imbalance: The patient's symptoms of hormonal imbalance, such as mood swings and short temper, along with the recent hysterectomy and conservation of ovaries, suggest that hormonal fluctuations could be the primary cause of her symptoms. The removal of the uterus can affect ovarian function, leading to hormonal changes.
• Other Likely Diagnoses
  • Anemia: Although the patient had an iron infusion post-operatively, the history of iron deficiency anemia and the symptoms of fatigue and shortness of breath on exertion could indicate a recurrence or persistence of anemia.
  • Deconditioning: Returning to full-time work after a significant surgical procedure, especially with initial light duties, might not have allowed for adequate physical recovery, contributing to fatigue and shortness of breath.
  • Vasovagal Syncope: The episodes of dizziness, loss of balance, and blurriness of vision could be indicative of vasovagal syncope, especially given the lack of postural drop in blood pressure and the nature of the episodes.
• Do Not Miss Diagnoses
  • Cardiac Causes (e.g., Arrhythmias, Cardiac Valve Problems): Although the cardiovascular examination is normal, it's crucial not to miss potential cardiac causes of dizziness and shortness of breath, as these can be life-threatening.
  • Neurological Disorders (e.g., Multiple Sclerosis, Peripheral Neuropathy): The symptoms of dizziness and balance issues, along with the episode of vision blurriness, warrant consideration of neurological disorders, even though the brief neurological assessment was normal.
  • Pulmonary Embolism: Given the recent surgery and the symptoms of shortness of breath and fatigue, pulmonary embolism, although less likely, is a critical diagnosis not to miss due to its high mortality rate.
• Rare Diagnoses
  • Addison's Disease: This rare endocrine disorder could cause hormonal imbalances, fatigue, and dizziness, although it would be unusual given the patient's recent surgical history and lack of other specific symptoms like skin hyperpigmentation.
  • Pituitary Apoplexy: A rare condition that could cause sudden hormonal imbalances and neurological symptoms, although it is more commonly associated with severe headache and visual disturbances, which are not prominently featured in this case.