Week 8 discussion bilateral knee pain
My colleagues have proposed the following differential diagnoses: hypothyroidism, diabetes mellitus, hyperthyroidism, and vitamin D deficiency. After analyzing all of these conditions, I would reject hypothyroidism due to its lack of symptoms in our patient. While this condition may present with fatigue and weight gain, these two characteristics are not significantly present in our patient. Additionally, hyperthyroidism could be ruled out as well due to its inconsistent presentation with symptoms such as heart palpitations or tremors which were not demonstrated during the exam.
In my opinion, vitamin D deficiency is most likely the diagnosis for this patient based on her presenting symptoms of anemia and bone pain. Vitamin D is essential for calcium absorption from dietary sources as well as maintaining adequate levels of phosphorus in the body so that calcium can be used by bones and muscles1. Deficiency in vitamin D disrupts this process resulting in a decrease in bone mineral density causing bone pain2. Furthermore, it has been linked to anemia through blocking red blood cell production3 making it a possible cause for both presenting symptoms in combination with other possible signs such as decreased appetite4 and muscle aches5 which could also be seen here.
Overall, while there are many possibilities when diagnosing a patient’s medical condition careful consideration must taken into account when analyzing their individual signs and symptoms before arriving at an appropriate conclusion such as favoring vitamin D deficiency here given our patient’s distinctive clinical presentation.
1 Bikle DD (2009). Vitamin D metabolism physiology and clinical implications.. Annu Rev Nutr 29: 105–128 ]
2 Hillman LS et al (2015). Vitamin d deprivation causes skeletal unloading deficits similar to disuse.. Bone 78: 153–164
3 Liu PT et al (2017). Low 25-hydroxyvitamin d concentrations are associated with lower hemoglobin concentrations among apparently healthy women.. Am J Clin Nutr 106(6): 1609–1615
4 Hathcock JN et al (1997). Risk assessment for vitamin d.. Am J Clin Nutr 65(2): 1628S–1637S 5 Murray CA et al (2014). An analysis of associations between various musculoskeletal pains complaints and serum 25-hydroxyvitamin d levels across gender groups.. Int Musculoskel Med 36(4): 215–220