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ClinicaldialoguefiveXiaoXiongLiDepartmentofneurologicalSurgeryRenJiHospitalPartoneD:Iseefromyournotesyouwereinhospital10yearsagowiththyroidtrouble.P:Yes,that’sright.D:Whathasactuallybeenhappeningsincethat?P:Allsortsofthings.I’vebeenfeelingverydepressedforayear.D:Didyougotoyourdoctor?P:Yes,hegavemesomeValiumtabletstoslowmedownbuttheyslowedmetoahalt.Ididnothingbutsleep.D:Didtheyaffectyouinanyotherway?P:Yes,Igotstomachtrouble,maybeindigestion,Ithink.D:Whatsymptoms?P:Allthefoodstaysuphere.(indicatingchest)D:Whendoyougetit?P:Twotothreehoursafterfood.D:Burningorstabbingpain?P:ItfeelslikesomewindthereandIwanttogetridofit.D:Doyoubelch?P:Notmuch.D:Doesitbotheryouatnight?P:No,itcomesonwhenIwashungryandIfeelI’llcollapseifIdon’teatstraightawayD:Howaboutyourappetite?P:Verypoor,itstartedtodeteriorate10yearsago.D:Whataboutyourweight?P:I’mloosingweight.D:Whataboutyourbowels?P:I’mconstipated.D:Howoftendoyouhavethemopened?P:OnlywhenItakemedicine.D:Everyday?P:No,everyotherday.D:Doyoualwayssweat?P:Yes,butmorerecently.D:Alloveryoubody?P:Yes,allover.D:Anydepressed,nervous,edgy,irritable?P:Yes,itstartedonemonthagobeforeIgotmyjob.D:Periodsregular?P:EverymonthsinceIhadmybabyfiveyearsago.D:Isthereanythingelseyou’venoticed?P:No.D:Hasanyoneinyourfamilyhadthyroidtrouble?P:No,Ihaveonesisterandtwobrothers,theyarewell.ParttwoD:Iseeyou’vebeenanaemicandyouhadabloodtestlastMay.Hasanythingelsetroubleyou?P:I’vekeptgettingaroaringinmyearsandgiddiness.D:Allthetime?P:Mostofthetime.D:Howlonghasallthisgoneon?P:Say,aboutsixmonths.D:Sinceyourtreatmentwithiron?P:Yes,Ikeepgettingdizzyspells.D:Doesanythingbringthemon?P:Rushingabout.SometimesIknowI’mfallingbutIcan’tstopmyself.D:Doyourlegsgiveway?P:Yes.D:Ifyoustandstill,doyouholdon?P:Yes.D:Areyouallrightbetweenspasms?P:Yes.D:Doesitaffectyourears?P:Igetroaringinmyears.D:Howlong?P:Minutes.D:Doyoufeelsick?P:Yes,firstthinginthemorning.Terribly.D:Doyousufferfromheadaches?P:MyperiodsareonlyhalfadayandIgetterriblyheadaches.D:Howoftendoyouhaveyourperiods?P:Itvaries,everytwoorthreeweeks.D:Isitalwayslikethat?P:Yes.D:Yousayyouarebreathless?P:Yes,IgetpuffedifIgoupstairs.D:Doyouhaveanyboweltrouble?P:No.D:Water?P:No.D:Doyougetupatnight?P:No.PartthreeD:Iseefromyournotesyoucametousayearagowithanoveractivethyroidgland.P:Yes,andIhadamiscarriageinMayandI’mnowpregnantagain.D:Whenisyourbabydue?P:Roughly10thJuly.D:Haveyoubeentakingpillsforyourgland?P:Istoppedaboutsixmonthsago.D:Howareyouatthemoment?P:IkeepfeelingqueerandmydoctorsuggestedIhadacheck-up.D:Doyoueverfaint?P:No,butIfeelfaint.D:Doyouactuallyflushorsweat?P:No,notasbefore.D:Haveyoubeengainingweight?P:Yes,Ididn’trealiseIwaspregnant.D:Areyourbowelsregular?P:Yes.D:Doyougomorethanonceaday?P:No.D:Theyarequitewell-formed,arethey?P:Yes.D:Howareyournerves?Areyoujittery,fidgety?P:No.D:Dothefamilygetonyournerves?P:Notnow.D:Wereyoureyesalwaysprominent?P:Yes.D:Areyouparticularlybotheredbyweather?P:No,Iusedtobebefore.D:Yousufferfrompalpitations?P:Yes,butI’vehadthemsinceIwasachild.D:Inyourself,youfeeldifferent?P:Oh,yes.