Vestibular Consult Letter Template

Ms. Parker, a female patient, describes persistent fatigue ongoing for approximately three months. Ms. Parker describes significant impact on her ability to perform occupational duties and care for her children. She describes associated symptoms including weight gain, irregular menstrual cycles, morning joint stiffness, hair thinning, constipation, and increased sensitivity to cold temperatures. Ms. Parker describes a family history of autoimmune thyroid disease, specifically Hashimoto’s thyroiditis in her mother. She does not describe any prior thyroid or autoimmune diagnoses. The impact of her symptoms on daily life is significant, particularly in relation to work and childcare responsibilities.

Physical examination:

Otoscopy:
• RIGHT: 
• LEFT: 

Halmagyi test: 
Tuning fork (512Hz) suggests a 

Gait:
EOM's: no gaze-evoked nystagmus, smooth tracking, no subjective diplopia, normal saccadic eye movement
CN II-XII: grossly normal
Appropriate ocular movements with head turns side/side, up/down, tilting
Cerebellar: no dysmetria, no dysdiadochokinesia 

Frenzel's:
• Gaze-evoked nystagmus: none  
• Headshake: no nystagmus post-headshake
• Romberg: normal
• Dix-Hallpike: 
• Supine: negative bilaterally

Audiogram:

Diagnostic imaging:

Impression:
1. Autoimmune thyroiditis (E06.3)
2. Vitamin D deficiency, unspecified (E55.9)

Plan:
1. Levothyroxine 50 mcg daily prescribed, to be taken on an empty stomach, ideally 30 minutes before breakfast. Advised to avoid taking with calcium or iron supplements.
2. Vitamin D supplementation at 2000 IU daily recommended. Follow-up Vitamin D panel scheduled in three months. Thyroid function tests to be rechecked in six weeks to evaluate effectiveness and adjust dosage if necessary. Monitoring of joint stiffness advised, with consideration for rheumatology referral if symptoms persist. Balanced diet and regular light physical activity encouraged. Follow-up appointment scheduled and prescriptions sent electronically.