Presenting Complaints

The patient presents with a chief complaint of mood swings over the past 6 months.

History of Presenting Complaint

The patient reports experiencing significant mood changes, including periods of irritability, sadness, and anxiety. She states that her mood can fluctuate several times throughout the day, with no clear triggers. She also reports feeling fatigued and having difficulty sleeping. The patient denies any recent stressful life events that could be contributing to her mood changes.

Significant Positives & Negatives For Differentials

Thyroid Dysfunction (Hypo- or Hyperthyroidism)

Positives:

• Mood changes (irritability, depression, anxiety)
• Fatigue
• Sleep disturbances
• Weight fluctuations
• Family history of thyroid disorder (mother's hypothyroidism)

Negatives:

• No other typical symptoms of hypo- or hyperthyroidism (e.g., cold/heat intolerance, changes in appetite, bowel habits, or menstrual cycle)
• No palpitations, tremors, or other signs of thyrotoxicosis

Adrenal Dysfunction

Positives:

• Mood changes (irritability, depression, anxiety)
• Fatigue
• Sleep disturbances
• History of hypertension (may indicate adrenal involvement)

Negatives:

• No other typical symptoms of adrenal dysfunction (e.g., weight changes, muscle weakness, salt cravings)
• No signs of Cushing's syndrome or Addison's disease

Pituitary Disorder

Positives:

• Mood changes (irritability, depression, anxiety)
• Fatigue
• Sleep disturbances
• History of hysterectomy (may indicate pituitary involvement)

Negatives:

• No other typical symptoms of pituitary disorders (e.g., headaches, vision changes, galactorrhea)
• No signs of pituitary hormone imbalances (e.g., growth hormone, prolactin, gonadotropins)

Mood Disorder (e.g., Depression, Anxiety)

Positives:

• Mood changes (irritability, depression, anxiety)
• Fatigue
• Sleep disturbances
• No clear triggering events or stressors

Negatives:

• No other typical symptoms of major depressive disorder or generalized anxiety disorder (e.g., anhedonia, changes in appetite, excessive worry)
• No history of previous mood disorder diagnoses

Past Medical History

The patient has a history of hypertension, which has been well-controlled with medication. She also had a hysterectomy 10 years ago due to uterine fibroids.

Drug/Medication History

The patient takes hydrochlorothiazide for her hypertension and occasionally takes over-the-counter sleep aids when she has trouble sleeping.

Social History

The patient is married and lives with her husband. She is retired after working as an accountant for 25 years. She denies any history of substance abuse.

Family History

The patient's mother had hypothyroidism, which was well-managed with medication.

Systems Review

• General: Fatigue, weight fluctuations
• Cardiovascular: Denies chest pain, palpitations, or edema
• Respiratory: Denies shortness of breath or cough
• Gastrointestinal: Denies nausea, vomiting, or changes in bowel habits
• Genitourinary: Denies incontinence or changes in urination
• Neurological: Denies headaches, dizziness, or changes in vision
• Psychiatric: Mood swings, irritability, anxiety, difficulty sleeping

Ideas, Concerns & Expectations

The patient is concerned that her mood swings are related to a hormonal imbalance and is hoping the doctor can provide a diagnosis and treatment plan to help manage her symptoms.

Case Presentation

Based on the patient's presentation, the most likely diagnosis is a menopausal hormone imbalance. The patient's mood swings, fatigue, and sleep disturbances, along with her age and history of a hysterectomy, strongly suggest a hormonal etiology. While other differential diagnoses, such as thyroid, adrenal, or pituitary disorders, as well as mood disorders, should be considered, the lack of other typical symptoms for these conditions makes a menopausal hormone imbalance the most likely explanation for the patient's symptoms.