5th April 2024

A 33-year-old chemistry teacher presents to her GP feeling generally unwell and upset

A 33-year-old chemistry teacher presents to her GP feeling generally unwell and upset. She gave birth one month ago but the delivery was complicated by a severe postpartum haemorrhage for which the patient received blood transfusions and had to stay in hospital for four days.

Over the last few weeks, she has struggled to produce enough milk to feed the baby and she is very upset about this. She is concerned she may have an infection as she feels constantly cold and exhausted. She also complains of feeling nauseous and has vomited four times in the last week. On examination, there is pitting oedema up to her knees bilaterally. Her temperature is 36.7C.

What is the most likely cause of the patient’s symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.