Abstract Body

Introduction: Fatigue is a common, nonspecific symptom with a broad range of etiologies including acute and chronic medical disorders, psychological conditions, medication toxicity, and substance use.

Case report: A 26-year-old woman resorts to the Health Unit with feelings of anguish, sadness, fatigue, crying spells and terminal insomnia with 2 months of evolution. In addition to concerns about her 8-year-old brother with cerebral palsy, she reported her parents were divorcing. She didn’t intend to start medication. She returns 3 weeks later with an analytical study that had no relevant findings. She agreed to start antidepressants. After 6 weeks only sleep had improve. The patient additionally reports that she was followed in adolescence by a thyroid nodule. The dosage of the antidepressant was titrated, and a thyroid ultrasound was requested. Two months later, there was an improvement in the mood complaints, but maintained fatigue. The ultrasound revealed a “solid nodular formation, hypoechoic, lobulated or two nodular formations”. A biopsy of the thyroid nodule was requested. Due to the suspicion of parathyroid adenoma, a measurement of serum calcium and PTH was requested, and both were elevated, favoring this last hypothesis. A general surgery appointment was requested, and the patient underwent a parathyroidectomy, leading to a resolution of the symptoms, namely asthenia.

Discussion: Fatigue is a non-specific symptom, which requires a careful etiological investigation. In this case, although it could have been a result of her mood disorder, there was an organic justification for her asthenia. The Family Physician must be watchful, trying to make a assertive differential diagnosis in cases with symptoms refractory to treatment.