[Answered]: Date/TimeProvider Progress Notes 04/17/20XX 1500…

Date/TimeProvider Progress Notes 04/17/20XX 1500 Chief Complaint: 45-year-old male presents with complaints of persistent fatigue, unexplained weight gain, and difficulty concentrating at work. Past Medical History: Negative; client and spouse undergoing an infertility evaluation Current Medications: OTC multivitamin; occasional OTC pain reliever; no prescription medications Family History: Mother history of thyroid dysfunction; father has type 2 diabetes; paternal grandmother experienced early-onset menopause Physical exam completed: General Appearance: Appears fatigued; mild puffiness around eyes; central obesity, with increased abdominal girth. Reports feeling cold despite the clinic being at a comfortable temperature. Skin: Dry skin and brittle nails noted. No obvious rashes or lesions. Head and Neck: No palpable thyroid nodules or enlargement. Pupils equal and reactive to light. Cardiovascular: Regular heart rate and rhythm with no murmurs or abnormal sounds. Respiratory: Clear breath sounds bilaterally. Abdomen: Soft, non-tender abdomen with no palpable masses. Increased adiposity concentrated in the abdominal region. Neurological: No focal neurological deficits. Cranial nerves intact. Musculoskeletal: No joint swelling or tenderness. Limited joint mobility due to obesity. 05/08/20XX 1633 A 45-year-old male returns for a 3-week follow-up after being diagnosed with primary hypothyroidism and initiating oral levothyroxine replacement therapy. Reports less fatigue, 8 lb weight loss, and improved concentration at work. Denies coldness when asked. Physical exam: Eyes are no longer puffy; central obesity remains, abdominal girth decreased by 3.5 inches; no palpable thyroid nodules or enlargement; pupils equally round and reactive to light and accommodation; regular heart rate and rhythm with no murmurs or abnormal sounds; clear breath sounds bilaterally; soft, non-tender abdomen with no palpable masses.