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Psychiatry


Answer 7
  1. TSH level. The patient’s symptoms of depression, constipation, cold skin, and weakness are suggestive of hypothyroidism. The incidence of hypothyroidism is increased in Parkinson’s disease.12 Hypothyroidism should always be considered in the differential diagnosis of depression occurring with Parkinson’s disease and therefore TSH and free thyroxine should be obtained.11 Magnetic resonance imaging of the brain and psychological testing are not indicated in this patient. Referral to a psychiatrist could be considered if TSH is normal and if the patient meets criteria for depression.

    REFERENCES
    11. Okun MS, Watts RL. Depression associated with Parkinson’s disease: clinical features and treatment. Neurology 2002;58(4 Suppl 1):S63-70.

    12. Berger JR, Kelley RE. Thyroid function in Parkinson disease. Neurology 1981;31:93-5.

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