Age: 61.0
Sex: F
Vaccine: COVID19, COVID19
Symptoms: Asthenia, Balance disorder, Blood thyroid stimulating hormone decreased, COVID-19, Cerebrovascular accident
Clinical narrative: Hospitalized 12/16/2021; COVID-19 positive 12/16/2021; fully vaccinated  BRIEF OVERVIEW: Discharge Provider: MD Primary Care Provider: MD Admission Date: 12/16/2021 Discharge Date: Dec 22, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Weakness [R53.1] Altered mental status, unspecified altered mental status type [R41.82] COVID [U07.1]  HOSPITAL COURSE:  The patient is a 62 yo woman with past medical history significant for history of left-sided brain oligodendroglioma status post resection, seizure disorder, hypothyroidism, history of CVA with chronic right leg weakness, with recent hosptialization 10/25-10/29 for weakness thought to be secondary to recrudescence of her prior CVA vs other. She was subsequently admitted at Inpatient Rehabilitation Center from 10/29-11/10/21 for ongoing right leg weakness. She was discharged in stable condition and felt she was doing well until 2 days ago. The patient was re-admitted on 12/16 due to generalized weakness, and fall as well as leftward tilting that has rapidly progresses over the past couple of days.  Patient was found to have COVID-19 infection and the working diagnosis at the time of admission was acute stroke versus regarding since of prior stroke versa generalized weakness due to COVID-19 infection versus thyrotoxicosis.  Patient's TSH was 0.09, free T4 was 1.9.  Initial CT head was negative for acute stroke or intracranial hemorrhages.  MRI of the brain was negative for acute stroke. In terms of COVID-19 infection, patient was fully vaccinated with Pfizer on 04/07 and 5/5.  Has not yet received booster.  She has not required any oxygen at the moment.  Does not appear to be in respiratory distress.  She was offered monoclonal antibodies. Patient has generalized weakness was likely is related to COVID-19 infection with associated uncontrolled hypothyroidism.  The patient 's Symptoms improved after COVID was treated and Synthroid adjusted.  Patient was evaluated by Endocrinology due to underlying hypothyroidism.  Thyroid ultrasound revealed large right lobe thyroid nodule.  Endocrinology increased her Synthroid to 112.5 mcg from 88 mcg.  Endocrine will plan an outpatient right thyroid nodule FNA - scheduled 1/6/2021 at 8:20 am. Following this, will anticipate referral to General Surgery for right hemithyroidectomy vs total thyroidectomy.  She will have a Repeat thyroid hormone blood test in 6 weeks. For age related osteoporosis, endocrine Recommend screening for secondary causes of decreased bone mass hyperparathyroidism, malabsorption/celiac disease, multiple myeloma, hypercalciuria w/ CMP, phosphorus, magnesium, PTH, celiac antibody cascade, SPEP/free light chains, 24h urine calcium/creatinine/sodium. This can be obtained with updated thyroid hormone blood tests in 6 weeks.Update as planned 1/2022 Patient was seen by PT/OT who initially recommended acute rehab but after evaluation they recommended subacute rehab. Her and her spouse were discouraged with this but ultimately accepted discharge to SAR but changed her mind that day so discharged home w/ HH RN and PT.