Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Resource Center
Testimonials
Share this Case Study
Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What can cause irregular and heavy periods?
How is PCOS diagnosed?
How heavy is too heavy for a period?
Can stress affect menstrual cycles?
What are common symptoms of hypothyroidism?
What is hyperprolactinemia and how does it affect menstrual cycles?
When should you see a doctor for menstrual irregularities?
How can an AI doctor help with menstrual irregularities?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Hi there! So, I understand that you're here to discuss your periods being irregular and sometimes heavy. Is that right?
Patient
Yes, that's correct.
Cody, the AI Doctor
Good to meet you! Let's talk more about your concerns. How long have you been experiencing these changes in your menstrual cycle?
Patient
It's been about three months now.
Cody, the AI Doctor
Can you describe what your irregular periods are like? Are they coming more frequently, less frequently, or just unpredictably?
Patient
They're pretty unpredictable. Sometimes they come a week early, and other times they can be almost two weeks late.
Cody, the AI Doctor
Thank you for the detail. Have you noticed any other symptoms accompanying these changes, such as weight gain, hair loss, or fatigue?
Patient
I've been feeling more tired than usual, and I've also noticed some weight gain, even though I haven't changed my eating habits much. Also, my skin has been breaking out a lot, and I'm not sure why.
Cody, the AI Doctor
Noted. Are your periods heavier than they used to be, lighter, or do they vary?
Patient
They're definitely heavier. Sometimes the bleeding is really heavy, and it can last longer than my usual periods.
Cody, the AI Doctor
I see. Beyond the weight gain and acne, have you experienced any hair changes, like thinning hair or increased facial hair?
Patient
My scalp hair seems to be thinning a bit, but I haven't noticed any unusual hair growth on my face or body.
Cody, the AI Doctor
Got it. Have you experienced any chronic illnesses, or are you currently on any medication or supplements?
Patient
No, I haven't had any chronic illnesses and I don't take any medication or supplements right now.
Cody, the AI Doctor
Is there any chance you might be pregnant?
Patient
No, I'm not pregnant. I checked a few times with home pregnancy tests, and they were all negative.
Cody, the AI Doctor
Have you ever tried to get pregnant?
Patient
No, never.
Cody, the AI Doctor
Thanks for clarifying. Have you ever been diagnosed with any conditions regarding your reproductive health, like PCOS or thyroid issues?
Patient
No, I haven't been diagnosed with anything like that before.
Cody, the AI Doctor
Good to know. How about any notable stress or significant changes in your life in the past few months?
Patient
I switched jobs recently, which has been a bit stressful, but nothing too extreme.
Cody, the AI Doctor
Stress can sometimes impact menstrual cycles, but let's dig a bit deeper. Have you experienced any nipple discharge or changes in your vision?
Patient
No, nothing like that.
Cody, the AI Doctor
Any family history of hormonal or thyroid disorders that you know of?
Patient
My mom has hypothyroidism. That's the only thing I can think of.
Cody, the AI Doctor
Alright. You mentioned feeling more tired and noticing skin changes. Have you been experiencing any significant menstrual cramps as well?
Patient
Yes, the cramps have been more intense than usual. They last longer and are more painful.
Cody, the AI Doctor
Thanks for providing all this information.
Cody's AI Summary
- You are a 28-year-old woman experiencing irregular and sometimes heavy periods for the past three months.
- Your symptoms include fatigue and weight gain, but no nipple discharge or vision changes.
- You have no history of taking medication or supplements, and you're not pregnant.
- You do have thinning hair and some skin breakouts.
- There is no family history of hormonal disorders except for your mother having hypothyroidism.
- Stress due to a recent job change may be a factor, but you report no other significant lifestyle changes.
- You have dry skin and increased tiredness without any unusual hair growth.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Polycystic Ovary Syndrome (PCOS)( 45% probability)
A common hormonal disorder in women of reproductive age, causing irregular periods and symptoms like weight gain and fatigue, and changes consistent with increased male hormones, such as thinning hair and acne.
2. Hypothyroidism(35 % probability)
A condition where the thyroid gland doesn't produce enough hormones, leading to symptoms like irregular periods, weight gain, fatigue, and dry skin. Given your family history, this remains a strong consideration.
3. Hyperprolactinemia(20 % probability)
Review by Dr Albert DiPiero
Dr. Albert DiPiero
In reviewing this case, the primary concern is the irregular and heavy menstrual cycles in conjunction with fatigue and weight gain and some skin changes. The top three AI diagnoses—PCOS, Hypothyroidism, and Hyperprolactinemia—are reasonable differentials.
1. Polycystic Ovary Syndrome (PCOS)(85% probability)
PCOS is highly likely considering the combination of menstrual irregularities and weight gain, thinning hair, and skin changes. Although the patient hasn't previously been diagnosed with any reproductive health issues, symptoms can often appear later in life or under stress.
2. Hypothyroidism(10% probability)
Hypothyroidism is a strong candidate given the patient’s family history and symptoms such as fatigue, weight gain, and dry skin. This condition is common and treatable with hormone replacement therapy.
3. Hyperprolactinemia(5% probability)
Hyperprolactinemia, while on the list, is less likely due to the lack of nipple discharge or vision changes, which are often associated with this condition.
Next Steps for Evaluation
Blood Tests: Evaluations including TSH, free T4, prolactin, and serum androgen levels would be critical in confirming hypothyroidism, hyperprolactinemia, or PCOS.
Ultrasound: A pelvic ultrasound can be helpful in diagnosing PCOS by identifying ovarian cysts.
Lifestyle Assessment: A discussion about stress management and recent life changes could be beneficial.
Potential Treatment Modalities
For PCOS: Lifestyle modifications, weight management, and hormonal contraceptives. Spironolactone is used to reduced hirsutism, acne, and hair loss in women. Atorvastatin can also reduce hirsutism.
For Hypothyroidism: Thyroid hormone replacement therapy.
For Hyperprolactinemia: Medications to lower prolactin levels if diagnosed.
Resource Center
Testimonials
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