For internal use only, not photocopiable

English for
Medical
Dr. Waode Hamsia, S.Pd, M.Pd.

Universitas Muhammadiyah Surabaya

Jl. Sutorejo No. 59 Surabaya 60117 |
Telp. (031) 3811966
CHAPTER 1
TAKING A MEDICAL HISTORY
A. INTRODUCTION AND RESPONSES
1. Introduction
- Let me introduce my self, my name is Doctor Dhian.
- I am Doctor Ryan, I will take care of you.
2. Note how the doctor starts the interview:
- What brings you here?
- What makes you come to this hospital?
3. Other ways of starting an interview are:
- What can I do for you?
- What seems to be problem?
4. Note how the doctor asks how long the problem has lasted
- How long have they been bothering you?
5. Another way of asking about this is:
- How long have you had them?

Practicing skills
Study this short dialogue.
Doctor : Good morning, I am Doctor Richard. Nice too meet you
Patient : nice to meet you Doctor, I am Mrs. Black.
Doctor : well, Mrs. Black, what’s brought you along today?
Patient : I’ve got a bad dose of flu (1)
Doctor : how long has it been bothering you?
Patient : two or three days. (2)

Practicing a Dialog
Make a pair group consists of two persons. One person acts as a doctor and the other
person acts as a patient. Use may use some response below.

(1) (2)
A bad dose of flu Two or three days
Terrible constipation Since Tuesday
Swollen ankles A fortnight
A pain in my stomach For almost a month

1
B. ASKING INFORMATION
1. Note how the doctor asks where the problem is:1
- Which part of your head is affected?
2. Otherways of finding this out are:
- Where does it hurt?*(hurt is a verb, My foot hurts)
- There is it sore? * (sore is an adjective, My foot is sore/ I have a sore foot)
3. Note how the doctor asks about the type pain:
- Can you describe the pain?
4. Other ways of asking this are:
- What’s the pain like?
- What kind of pain is it?

Lets practice
Practice the dialog with a friend next to you!

Doctor : which part of your head (chest, back, etc.) is affected?

Patient : just here.
Doctor : Can you describe the pain?
Patient : It's a dull sort of ache. (1)

Replace the expression on (1) with the expression below and practice the dialog again!
- a dull sort of ache
- a feeling of pressure
- very sore, like a knife
- a burning pain

C. ASKING PATIENT’S CONDITION

1. Note how the doctor asks if anything relieves the pain of headaches:
- Is there anything that makes them better?
2. Similarly he can ask:
- Doesanything make them worse?
3. Doctors often ask if anything else affects the problem. For example:
- What effect does food have?
- Does laying down help the pain?

2
Let’s practice
Read and practice the dialog below

DOCTOR: Where does it hurt?

PATIENT: Right across here. (Indicating the central chest area)
DOCTOR: Can you describe the pain?
PATIENT: It's like a heavy weight pressing on my chest.
DOCTOR: Does anything make it better?
PATIENT: If I stop for a bit, it goes away.

Tasks 1
Complete the situational dialog below based on the example above!
1. DOCTOR: __________________________
PATIENT: Here, just under my ribs. (1)
DOCTOR: __________________________
PATIENT: It gets worse and worse. Then it goes away.
DOCTOR: ___________________________
PATIENT: Food makes it worse.
2. DOCTOR: ___________________________
PATIENT: It's right here. (2)
DOCTOR: ___________________________
PATIENT: It's a gnawing kind of pain.
DOCTOR: ___________________________
PATIENT: Yes, if I eat, it gets better.
3. DOCTOR: ___________________________
PATIENT: Down here. (3)
DOCTOR: ___________________________
PATIENT: It's a sharp, stabbing pain. It's like a knife.
DOCTOR: ___________________________
PATIENT: If I take a deep breath, or I cough, it's really sore.
4. DOCTOR: ___________________________
PATIENT: Just here. (4)
DOCTOR: ___________________________
PATIENT: My chest feels raw inside.
DOCTOR: ___________________________
PATIENT: When I cough, it hurts most.

3
Task 2
Make a question that might be asked by a doctor to the patient based on the clinical
details below!

Task 3
Read the following case history and find and underline this information about the patient
and quick as possible.

1. previous occupation
2. initial symptoms
3. Initial diagnosis
4. Condition immediately prior to admission
5. Reason for emergency admission
6. Duration of increased thirst and nocturia
7. Father’s cause of death

4
 8. Alcohol consumption

CASE HISTORY

Mr. Wildgoose, a retired bus driver, was unwell and In bed with a cough and general
malaise when he called in his general practitioner. A lower respiratory tract infection was
diagnosed and erythromycin prescribed. Two days later, at a second home visit, he was found to be
a little breathless and complaining that he felt worse. He was advised to drink plenty and to
continue with his antibiotic. Another 2 days passed and the general practitioner returned to find the
patient barely rousable and breathless at rest. Emergency admission to hospital was arranged on the
grounds of 'severe chest infection'. On arrival in the ward, he was unable to give any history but it
was ascertained from his wife that he had been confused and unable to get up for the previous 24h.
He had been incontinent of urine on a few occasions during this time. He had been noted to have
increased thirst and nocturia for the previous 2 weeks.

His past history included appendicectomy at age II years, cervicalspondylosis 10 years ago,
and hypertension for which he had been taking a thiazide diuretic for 3 years. His father had died at
62 years of myocardial infarction and his mother had had rheumatoid arthritis. His wife kept
generally well but had also had a throat infection the previous week. Mr. Wildgoose drank little
alcohol and had stopped smoking 2 years previously..
Task 4
Study these case notes. What questions might the doctor have asked to obtain the
information they contain?

5
Work in pairs and try to recreate the consultation. Student A should start.

Student A : Play the part of the patients. Use the case notes as prompts.

Student B : Play the part of the doctor. Find out what the patient is complaining of. Do
not look at the case notes!

D. CHECKING MEDICAL PROBLEMS

Note how the doctor asks about the systems:

- Do you have any trouble with your stomach or bowels?

- What’s your appetite like?
- Any problems with your waterworks?
- What about coughs or wheezing or shortness of breath?
- Have you noticed any weakness or tingling in your limbs?

Lets practice
Match each of the suspected problems in the A column with a suitable question from B
column.

A. Suspected problem B. Question

1) Depression a. Have you had any pain in your chest?
2) cardiac failure b. Do you ever get wheezy?
3) asthma c. What sort of mood have you been in recently?
4) prostate d. Any problem with your waterworks?
5) coronary thrombosis e. Have you ever coughed up blood?
6) cancer of the lung f. Have you had any shortness of breath?

Your lecture will read the following expression, listen and identify the intonation used in
those expressions

- Any pain in your muscles?

- Have you lost any weight?
- Have you had a cough at all?
- Is there any blood in it?
- Have you had any pains in your chest?

Note:When we ask Yes/No questions like these, we normally use rising intonation. Note
that the voice changes on the important word. For example: Any pain in your muscles?

6
Let’s Practice It

Task 5
Study this extract from a case history!

The patient was a 59-year-old man, head of a small engineering firm (I),
who complained of central chest pain (2) which occurred on exertion (3)
and was sometimes accompanied by sweating (4). He smoked 40 cigarettes
a day (5). The pain had first appeared three months previously (6) and was
becomingincreasingly frequent (7), He had noticed some weight gain
recently (4 kg) (8) and also complained that his hair had become very dull
and lifeless. He felt the cold much more than he used to. He denied any
palpitations (9) or ankle oedema (10).

What questions might a doctor ask a patient to obtain the information in italics in the case
history? Use the question types studied previously. You may ask more than one question
for each piece of information.

For example:

a) what’s your job?

b) What's brought you along today? which part of your chest is affected?
c) When you have finished, put your questions in the most natural order for a
consultation.

Task 6
Read the description of each patient below

You are a 60·year-old electrician (male).

You have coughed up blood several limes over the last few weeks.
You have noticed that you're losing weight
Your clothes don't fit you properly.
You smoke 30 cigarettes a day.
You are 68. You are a retired schoolteacher (male).
You have been getting more and more constipated over the past few months.
You've noticed blood in your stools. You've been losing weight.
You are 45. You are a housewife. You have three children.
You get a pain in your stomach after meals.
Sometimes you feel squeamish.
Fried and oily foods seem to be worse
You are a 24-year-old typist (female).
You have pain when you are passing water. There is blood in your urine.
You have to pass water more frequently than usual.
You are a student of 19 (male).
You have a headache at the front of your head, along the brow.
Your nose keeps running.
Your headache is worse in the morning when you gel up.
It also gets worse when you bend down.

7
Work in pairs. Student A should start. Use proper question. Do a role play! And write the
medical report!

Student A : Play the part of the patient. Base your replies on the information given
in the table above.
Student B : Play the part of the doctor. Find out what the patient is complaining
of.

Task 7
Match each of the medical terms for common symptoms in the first column with a term
which a patient would easily understand or might use, from the second column.

Medical term Non-medical term

1. Paraesthesia a. swelling, puffiness
2. productive cough b. indigestion
3. anaesthesia c. coughing up phlegm or spit
4. retrosternal chest pain d. trouble holding your water
5. orthopnea e. cramp in the leg muscles which comes and goes
6. stress incontinence f. numbness
7. dysmenorrhoea g. sleeplessness
8. dyspepsia h. out of breath, out of puff, breathlessness
9. oedema i. painful periods
10. intermittent claudication j. pain behind the breast bone
11. insomnia k. pins and needles
12. dyspnea l. shortness of breath when you lie down

8
CHAPTER 2
TELLING SCHEDULE
A. ASKING AND TELLING ABOUT TIME

Second (n) : detik

Minute (n) : menit
Hour (n) : jam
p.m (post meridiem) : kurun waktu antara jam 12 tengah hari sampai jam 12 tengah
malam.
a.m (ante meridiem) : waktu antara jam 12 malam sampai jam 12 tengah hari.

“good evening” diucapkan pada malam hari saat bertemu. “good night” di ucapkan
pada malam hari saat berpisah.

Note: (n) = noun

1. Asking about time

 Excuse me. What time is it now (by your watch)?

2. Responses
 It’s + minute + PAST + main hour
 It’s + minute + TO + main hour

Examples:
X : Excuse me, What time is it now?
Y : it’s ten past two

NOTE:
A quarter = fifteen (minutes)
A half = thirty (minutes)
……. O’clock = used only at full hour (exact hour)

A.M = ante meridian (before 12 at noon)

P.M = post meridian (before 12 at mid night)

9
B. ASKING AND TELLING ABOUT DATES
Study and practice these useful expressions

 What date is it today?

 When were you born?
 When were you admitted to this hospital?

Response

 it’s (is/was) on ……….

Write Say
14 Jan (uary) 1990 January the fourteenth nineteen ninety (BE)
14.1.90 (GB) January the fourteenth nineteen ninety (BE)
1.14.90 (US) January fourteenth nineteen ninety (AE)
5 Apr(il) 1892 April the fifth eighteen ninety two
9 Dec(ember) 1600 December the ninth sixteen hundred
5 Nov(ember) 1804 November the fifth eighteen hundred and four

C. ASKING AND TELLING ABOUT DOCTOR’S SCHEDULE

Study and practice these useful expressions!

1. Asking Schedule
 When can I visit ………. (doctor’s name or speciality)
 Pardon me, do you know when dr ………… is available?
 When is it my turn?

2. Responses
 It is …….. / it’s ………..
 The internist’s/ Dr ………’s schedule is at …… +(hour) /on ……. +(day)
 The obstetrician /she/he is available at …… +(hour) /on ……. +(day)
 The obstetrician /she/he will be available at …… +(hour) /on ……. +(day)

Lets practice
Say these dates!

14 Jan 1978 13 Aug 1066 3 Mar 1860

21 Sept 1980 10 Oct 1906 19 Oct 1969

10
 Answer these questions orally!
1. What date is it?
2. What date is it tomorrow?
3. What date is it after tomorrow?
4. What date was it yesterday?
5. What date was it before yesterday?
6. When were you born?

3. Task1
Translate this exchange into English (V: Visitor) (N: Nurses)

1. V: saya pasien dr. Stewart. Jam berapa saya hari ini bisa bertemu?
N: saya cek jadwalnya dulu, Baik, anda bisa ketemu pk. 16.30
V: _____________________________________________________________
N: _____________________________________________________________

2. V: hari apa saja ada dokter spesialis anak?

N: dokter spesialis anak? Sebentar ya bu …. Dokter spesialis anak ada pada hari
Selasa dan Jum’at.
V: jam berapa jadwalnya?
N: pagi jam 8 sampai jam 12. Sore jam 4 sampai jam 6.
V: ____________________________________________________________
N: ____________________________________________________________
V: ____________________________________________________________
N: ____________________________________________________________

3. V: suster, kapan jadwal kunjungan pasien dr. William.

N: iya sudah datang. Iya akan mengunjungi Anda kira-kira jam 8.15.
V: _____________________________________________________________
N: _____________________________________________________________

4. V: Suster, Jam berapa operasi bedah nya akan dimulai?

N: operasi? Hari ini jam 10 tepat.
V: _____________________________________________________________
N: _____________________________________________________________

5. V: Maaf, jam berapakah jadwal kunjungan dirumah sakit ini?

N: jam 10 pagi sampai jam 12 dan jam 6 sampai jam 8 sore.
V: _____________________________________________________________
N: _____________________________________________________________

11
4. Task 2
Role play
1. Practice the above dialogue with your partner
2. N: Nurse, P: patient

5. Task 3
Conversation 1: Current time
Create your own situation of patient and nurse conversation about current time!
For example:
 Patient : what time is it?
 Nurse : it is……….

6. Task 4
Conversation 2: Doctor’s schedule
Create your own situation of doctor and nurse conversation about doctor’s schedule!
For example:
 Doctor : when can I see the obstetrician today?
 Nurse : the obstetrician will be on duty at …..

7. Task 5
Conversation 3: Turn
Create your own situation of patient and nurse conversation about current time!
For example:
 Doctor : nurse, what time can I begin my turn?
 Nurse : yes doctor, your turn is at …………

8. Task 6
Make a dialog based on the situation below and practice with your partner.
(D: doctor) (N: nurse)
a. D asks N about the time his mother passed away.
b. D asks N about when visitor’s visiting time starts in the afternoon.
c. D asks N about patient’s visiting schedule.
d. D tells the patient about the schedule or radiology room.
e. D tells the patient about the schedule of taking medicine.

12
CHAPTER 3
DESCRIBING HUMAN DISEASES
AND MEDICAL JOB
Task 1
Make group consists of 4 -5 persons. Mention part of the body and find diseases that might
happen on it.

Part of the body Diseases

1. Head Headache, vertigo, ………..

1. Job Description
Asking someone’s job description
No. Formal Informal
1 Could you tell me what your duties are? What are your duties?
2 I would like to know whether you know What is your responsibility?
about your responsibility
3 Can you tell me what your task is? What is your task?
4 I would like to know what you have to do What do you have to do?

Telling about someone’s job description

a. Receive guests and in-coming phone calls
b. A PR officer is a responsible for building a good relationship
c. My duties are to offer the menu and to take the orders.
d. I have to make medical reports.

13
2. Educational Background
Asking someone’s Educational Background

No. Formal Informal

1 Could you tell me a little about your What is your educational
educational background? background?
2 Can you tell me where you graduated from? Where did you graduate from?
3 I would like to know about your major What is your major?
4 I would like to know where you study Where do you study?

Telling someone’s Educational Background

a. I graduated from medical wifery collage.

b. I have a degree in nursing.
c. I majored in pharmacy.
d. My major is medical wifery.

Task 1
Work in group and describe the duty of each medical specialization!

Name of specialization Duty

1. Dentist A surgeon who specializes in dentistry- the diagnosis,
prevention, and treatment of diseases and condition of
oral cavity.
2. Oncologist
3. Dermatologist
4. Orthopedy
5. Cardiologist
6. Neurologist
7. Gynecologist
8. Urologist
9. Pulmonologist

Find more and describe it!

Task 2
Make a dialog about someone’s educational background and the description of his job then
present it in front of the class.

Task 3
Individual work!
Make an essay about describing a medical profession in a piece of paper!

14
CHAPTER 4
EXAMINING A PATIENT
A. USEFUL EXAMINATION EXPRESSION
1. Note how the neurologist explains what she is going to do in Part I of the
examination:
- I now want to ...
- I’m going to ...
- I will ...
2. To instruct the patient, she uses:
- I want you to ...
3. To mark the stages of her examination, she says:
- Now, I'm going to fry something ...
- Next, I’m going to test you….
4. Explain what she is going to do and why.
- Now I'm going to take some fluid off your back to find out what's giving you these
headaches.
5. Instruct the patient to take up the correct position.
- Now I want you to move right to the edge of the bed.
6. Reassure the patient about the investigation.
- It won't take very long
- Now I'm going to give you a local anesthetic so it won’t be sore.
7. Doctors often combine reassurance with a warning. Study these examples from a
sternal marrow investigation:
- It shouldn't be painful, but you will be aware of a feeling of pressure.
- This may feel a little bit uncomfortable, but it won't take long.
-

Task 1
Here is part of a doctor's explanation during a sternal marrow investigation. The
explanation has been put in the wrong order. Try to rearrange it.

a) Now I'm going to give you an injection of local anesthetic. First into the skin and
then into the bone.
b) Then we'll put a dressing over the area
c) Now the next thing I'm going to do is to put a towel, a clean towel, over the area
d) First of all, I'm just going to wash the area with a bit of antiseptic.
e) Just going to remove the needle from your chest.
f) Now we're ready to do the actual test.
g) Now I'm going to remove the actual cells from your bone.

15
B. GENERAL EXAMINING
1. Note how the doctor instructs the patient what to do:
- Now I just want to see you standing.
- Could you bend down as far as you can?
- Keep your knees and feet steady.
2. Instructions, especially to change position or remove clothing, are often made
like this:
- Would you slip off your top things, please?
- Now I would like you to lean backwards.
3. The doctor often prepares the patient for the next part of the examination in this
way:
- I'm just going to find out where the sore spot is.

Task 2
Study this checklist for the first examination of a patient on attendance at an antenatal
clinic. Some of these examinations are carried out as routine on subsequent visits. Mark
them with a tick (√) on the checklist.

Now study these extracts from an obstetrician's examination of a patient attending for her
32-week antenatal appointment. Match each extract to the numbered examinations on the
checklist. For example:

a) Have you brought your urine sample? __5____

b) Now would you like to sit up and I'll take your blood pressure? ________
c) Now I'll take a sample of blood to check your hemoglobin _______.
d) Have you noticed any swelling of your ankles? ______ Let’shave a quick look.

16
 e) Now if you'd like to lie down on the couch, I'll take a look at the baby. I'll just
measure to see what height it is.

Task 3
Find out the information of the following antibioticsprescription (including: indication,
cautions, contra-indications, side-effect, and dose).

1) Amoxicillin
2) Erythromycin
3) Phenoxymethyl Penicillin
4) Tetracycline
5) Cefuroxime
6) Benzyl Penicillin
7) Tetracycline
8) Gentamicin
9) Cefotaxime

Task 4
Using the prescribing information that you have found, choose the most appropriate
antibiotic for these patients.

1) A 4-year-old-boy with meningitis due to pneumococcus. He is allergic to

penicillin.
2) A 57-year-old man with a history of chronic bronchitis now suffering from
pneumonia. The causative organism is resistant to tetracycline.
3) A 27-year-old woman with urinary tract Infection in early pregnancy.
4) A 4-year-old girl with septic arthritis due to haemophilus influenza,
5) 5 An 18-year-old man with left leg amputation above the knee following a road
traffic accident
6) A 50-year-old woman with endocarditis caused by strep. vindans.
7) A 13-year-old girl with disfiguring acne.
8) An 8-yp.ar-old boy with tonsillitis due to B-hemolytic streptococcus.
9) A 43-year-old dairyman with brucellosis.
10) A 4-year-old unimmunized sibling of a 2-year-old boy with whooping cough.

C. SPECIALEXAMINATIONS
1. Note how the doctor starts the examination:
- I'd just like to .. .
- Could you just ... for me?
2. Note how the doctor indicates the examination is finished;
- Right, thank you very much indeed.

17
Task 5
You want to examine a patient. Match the following examination and the instruction!

Examinations Instructions
the throat Remove your sock and shoe.
the ears Remove your top clothing.
the chest Turn your head this way.
the back Open your mouth.
the foot Tilt your head back.
the nasal passage Stand up.

Then work in pair and practice the examining expression above by rephrasing the
instructions, For example: I would just like to examine your throat. Could you please
open your mouth as wide as you can?

Task 6
What do you think the doctor is examining by giving each of these instructions?

1. I want you to push as hard as you can against my hand.

2. Breathe in as far as you can. Now out as far as you can.
3. Say 99. Now whisper it.
4. Could you fix your eyes on the tip of my pen and keep your eyes on it?
5. I want you to keep this under your tongue until I remove it.
6. Would you roll over on your left side and bend your knees up? This may be a
bit uncomfortable.
7. I want to see you take your right heel and run it down the front of your left leg.
8. Put out your tongue. Say Aaaa…

18
D. MENTAL IMPAIRMENT EXAMINATIONS
The form below is used to measure mental impairment. Discuss with a partner:

- In what order you might ask these questions?

- In what form you might ask them?

1. Note how the doctor uses a rephrasing technique to encourage the patient and
give him lime 10 answers. For example:
- Question 9: Have you been here long?
in this house, have you been here long?
How long have you been living in the high Street?
2. Note also that the rephrased question is often preceded by an expression like
Do you remember ... ?
For example: Do you remember where this is? Where is this place?

Task 7
Using the expressions studied in this chapter. Choose a study case of examination and
make a dialog including an explanation to a patientabout each stage of the examinations
and instruct him.

19
CHAPTER 5
MAKING A DIAGNOSIS
A. USEFUL EXPRESSION
1. Note these expressions used between doctors in discussing a diagnosis.

Certain Fairly certain Uncertainty

Yes is seems might
must probably could
likely may
No can't unlikely possibly
definitely not a possibility
exclude
rule out

2. We are still uncertain. We can say:

- The patient might have cervical spondylosis.
- Cervical spondylosis is a possibility.
3. The findings on examination provide more evidence. Some diagnoses become
more likely while others become less likely. We can say:
- He seems to have temporal arteritis.
- There is no neck stiffness. It's unlikely that he's got cervical spondylosis.
4. The results of the investigations provide stronger evidence for our final
diagnosis. We can say:
- A raised ESR makes temporal arteritis verylikely.
- Normal MRI scanexcludes a space-occupying lesion.
- He can't have a space-occupying lesion.
5. Finally, following the biopsy, We can say:
- - He must have temporal arteritis.

Note:

When explaining a diagnosis, a patient would expect you to answer the following
questions:
1. What's the cause of my problem?
2. How serious is it?
3. What are you going to do about it?
4. What are the chances of a full recovery?
In explanations, it is important to use straightforward. Non-specialist language with
only such detail as is important for the patient's understanding of the problem. You
can make sure your explanations are easily understood by avoiding medical
terminology where possible and defining the terms you use in a simple way.

20
 Task1
Write simple explanations for patients of these terms. Compare your explanations
with those of other students.

1. the pancreas
2. the thyroid
3. fibroids
4. emphysema
5. arrhythmia
6. bone marrow
7. the prostate gland
8. gastro-esophageal reflux

B. CAUSE AND EFFECT

1. Explanations often involve describing causes and effects. Look at these
examples:

Cause Effect
bend the knee the tension is taken off the nerve
straighten it the nerve goes taut

2. We can link a cause and an effect like this:

- If we bend tile knee, the tension is taken off the nerve.
- If we straighten it, the nerve goes taut.

Note: that both the cause and effect are in the present tense because we are
describing something which is generally true.

Task 2
Write a suitable effect for each of these causes. Then give each cause and effect to
make a simple statement you could use in an explanation to a patient.

1. The stomach produces too much acid.

2. A woman gets German measles during pregnancy.
3. You vomit several times in quick succession.
4. Your skin is in contact with certain plants.
5. Your blood pressure remains high.
6. You give your baby 100 much fruit
7. The cholesterol level in the blood gets too high.
8. There are repeated injuries to a Joint.

21
Task 3
How would you explain these diagnoses to the following patients or their relatives?

Work in pairs. Student A should start. A: Play the part of the doctor. Explain these
diagnoses to the patients or their relatives below. B: Play the part of the patients. In 2
and 6, play the part of a parent and in 5 plays the part of the son or daughter.

1. A 33-year-old salesman suffering from a duodenal ulcer.

2. A 6-year-old boy with Perthes' disease, accompanied by his parents.
3. A 21-year-old professional footballer with a torn meniscus of the right knee.
4. A 43-year-old teacher with fibroids.
5. An 82-year-old retired nurse suffering from dementia, accompanied by her
son and daughter.
6. A 2-week-old baby with tetralogy of Fallot, accompanied by her parents.
7. A 35-year-old receptionist suffering from hypothyroidism.

22