Differential Diagnosis

The patient presents with a complex array of symptoms including persistent dizziness, hair loss, body odor, menstrual irregularities, and significant bloating. Given the combination of symptoms and the patient's history, the following differential diagnoses are considered:

• Single Most Likely Diagnosis
  • Hypothyroidism: Despite a normal thyroid check two years ago, the onset of hair loss, menstrual irregularities, and significant bloating after discontinuing semaglutide, along with the patient's symptoms of dizziness and vertigo, could suggest a new onset or worsening of hypothyroidism. Thyroid function can fluctuate, and symptoms can be non-specific, making this a plausible diagnosis given the constellation of symptoms.
• Other Likely Diagnoses
  • Vestibular Migraines: Given the family history and previous successful treatment with the Epley maneuver, vestibular migraines are a strong consideration for the patient's dizziness and vertigo symptoms.
  • Nutritional Deficiencies: The patient's use of semaglutide and subsequent weight loss, followed by discontinuation and onset of hair loss, could indicate nutritional deficiencies, particularly given her report of taking supplements while on semaglutide. Deficiencies in iron, vitamin B12, or other nutrients could contribute to her symptoms.
  • Polycystic Ovary Syndrome (PCOS): The patient's menstrual irregularities, significant weight loss followed by hair loss, and symptoms suggestive of prolonged ovulation could be indicative of PCOS, especially considering the potential metabolic effects of semaglutide.
  • Gastrointestinal Disorder: Despite previous negative workups, the patient's significant bloating and feeling sick after eating could suggest an undiagnosed gastrointestinal disorder, such as irritable bowel syndrome (IBS), small intestine bacterial overgrowth (SIBO), or another condition not yet identified.
• Do Not Miss Diagnoses
  • Pituitary Adenoma: Although less likely, a pituitary adenoma could cause menstrual irregularities, hair loss, and potentially contribute to the patient's dizziness and vertigo through mass effect or hormonal imbalance. This diagnosis is critical not to miss due to its potential for significant morbidity if left untreated.
  • Adrenal Insufficiency: This condition could present with non-specific symptoms such as dizziness, hair loss, and menstrual irregularities. Given the patient's use of semaglutide and subsequent discontinuation, an evaluation for adrenal insufficiency is warranted, especially if other diagnoses are ruled out.
• Rare Diagnoses
  • Autoimmune Disorders (e.g., Lupus, Rheumatoid Arthritis): While less likely, autoimmune disorders can present with a wide range of non-specific symptoms including hair loss, menstrual irregularities, and potentially contribute to dizziness and vertigo.
  • Multiple Endocrine Neoplasia (MEN) Syndromes: These rare genetic disorders affect the endocrine system and could potentially explain the patient's array of symptoms, including menstrual irregularities and hair loss, although they would be a less common consideration without additional suggestive findings.