Girl with depression and constipation

Dr Mattias Larsson*

Up to the age of 12, Hương was a lively girl full of energy. However, at 13 her parents noticed that she was often in a depressed mood, avoided friends and often said she was tired and freezing cold despite the hot weather. She also complained of constant constipation, as well as joint and muscle pain.

Dr Mattias Larsson. Photo courtesy of Family Medical Practice

The parents took her to a local physician that made a physical examination and diagnosed intestinal infection, treated with mebendazole for parasites as well as antibiotics, with little effect.

Hương got a referral to a psychiatrist who prescribed antidepressant, also that had very little effect. As the years went on the parents and Hương got used to her condition, the depressed mood, constipation and pain.

Hương also noticed that she had increasingly pale skin and dry hair, the parents thought she spent too much time inside the house on her mobile phone.

However, they also noticed that she did not grow as fast as her classmates, when she was 15 years old, she was still about the same length as when 12, however the classmates had grown a lot.

The parents had heard that Family Medical Practice had good paediatric and adolescent care with international standards.

When arriving they met the paediatrician who listened to their story, assessed the growth chart which showed that Hương was -3 standard deviations in length but normal in weight, and had not grown much the last three years, the period that she was supposed to have gone through growth spurt.

The parents explained that she was eating well, and she was not underweight. During examination the doctor noticed Hương had some facial swelling and slow heartbeat. The doctor explained that they needed to take some tests including CBC, thyroid hormones, growth hormones, vitamin and nutrition markers.

After some hours the doctor called about the test results, it showed that Hương had hypothyroidism, a very common condition, and asked them to come back to FMP to explain results and do some additional examination.

The doctor showed the results and explained that free T4 and T3 levels were low and the thyroid stimulating hormone (TSH) was elevated, the growth hormone levels were normal which indicated that there was no problem with the pituitary gland.

Ultrasound showed that the thyroid gland was enlarged, and an additional blood test showed that the TPO antibodies were elevated, indicating autoimmune or Hashimoto's thyroiditis.

The doctor explained that the immune system normally protects the body by attacking bacteria and viruses. However, sometimes the immune system reacts against the body which may cause tissue destruction.

In Hashimoto thyroiditis the immune system attacks the thyroid gland causing inflammation of the thyroid gland. The thyroid gland becomes overrun with white blood cells, scarred and can’t make enough of the thyroid hormones, causing symptoms such as fatigue, depression, constipation, feeling cold and joint pain. The condition can however be easily treated when diagnosed.

Hương was initiated on Thyroxine (Levaxin) treatment. At follow-up after six months her growth had cached up, she had no constipation, felt better with no depression, did not freeze and had regular periods.

The doctor explained that as Hương was diagnosed with hypothyroidism and treated before the growth plates in the bones disappeared, she would most likely reach her expected length. The parents and Hương felt content that she got diagnosis and treatment before it was too late. Family Medical Practice

*Dr Mattias Larsson is a paediatric doctor at Family Medical Practice and associate professor at Karolinska Institute and has a long experience in research on infectious diseases. He has worked with the Oxford University Clinical Research Unit and the Ministry of Health of Việt Nam. He is fluent in English, Swedish, Vietnamese, German and speaks some Spanish.

Family Medical Practice - FMP Healthcare Group operates medical centres in major cities including HCM City, Hà Nội and Đà Nẵng, offering consultations with international doctors, check-up centres and emergency ambulance services. In HCM City, we have clinics in Districts 1, 2, and 7, along with the Care 1 - Executive Health Check-Up Centre and internationally accredited *9999 emergency ambulance services.