CHIEF COMPLAINT: Metastatic thyroid cancer to the lungs.

PRESENT ILLNESS: The patient is a 53-year-old
female with a history of hypertension, non-insulin-dependent
diabetes mellitus, and a long history of multinodular goiter,
which has doubled in size recently.  The patient was admitted
on [**8-/2186**] and found to have D-differential papillary
carcinoma on fine-needle aspiration.  The patient was also
found to have multiple pulmonary nodules on chest CT and
chest x-ray at that time, and the patient was admitted on
[**2186-9-13**] with shortness of breath and aspirate of right
lower lobe nodule at that time revealed malignant cells.  The
patient was scheduled for total thyroidectomy with the
surgery team on [**9-29**] with plan to pursue adjuvant
chemotherapy and XRT to the surgical bed.  The patient was to
receive carboplatinum and Taxol as the chemotherapeutic
regimen.  The patient had a CAT scan at that time, which
revealed multiple pulmonary nodules.  The patient presented
with progressive shortness of breath, nonproductive cough,
right sided chest discomfort.  Postoperatively, the patient
had increased hypoxia.  The patient was found to have small
PEs on CT angiogram.  The patient was heparinized and
coumadinized at that time.  The patient was started on
decadron prechemotherapy and the course was complicated by
possible pneumonia on chest x-ray.  There was no complaints
of chest pain, nausea, vomiting, abdominal pain, or pleuritic
chest pain that the patient recalls.

MEDICAL HISTORY: 1.  Thyroid cancer, tissue biopsy awaiting diagnosis with
pulmonary metastasis, diagnosed by FMA as D-differentiated
papillary carcinoma versus medullary carcinoma.
2.  Multinodular goiter times 34 years.
3.  Hypertension.
4.  Non-insulin-dependent diabetes mellitus on oral
hypoglycemics.

MEDICATION ON ADMISSION: 1.  Glucophage b.i.d.
2.  Uniretic 25/15 q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 1.  Hypertension.
2.  "Thyroid disease."
3.  No history of cancer, of which the patient is aware.

SOCIAL HISTORY: The patient lives with her daughter.  T was
born in [**Location (un) 4708**].  The patient was a day care provider and
has three children.  The patient denies tobacco or alcohol
use.
Malignant neoplasm of thyroid gland,Secondary malignant neoplasm of other specified sites,Secondary malignant neoplasm of lung,Iatrogenic pulmonary embolism and infarction,Pneumonia, organism unspecified,Other disorders of neurohypophysis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified
Malign neopl thyroid,Secondary malig neo NEC,Secondary malig neo lung,Iatrogen pulm emb/infarc,Pneumonia, organism NOS,Neurohypophysis dis NEC,Hypertension NOS,DMII wo cmp nt st uncntr,Anemia NOS
Admission Date:  [**2186-9-29**]       Discharge Date:  [**2186-10-13**]

Date of Birth:   [**2133-2-21**]       Sex:  F

Service:

CHIEF COMPLAINT:  Metastatic thyroid cancer to the lungs.

HISTORY OF THE PRESENT ILLNESS:  The patient is a 53-year-old
female with a history of hypertension, non-insulin-dependent
diabetes mellitus, and a long history of multinodular goiter,
which has doubled in size recently.  The patient was admitted
on [**8-/2186**] and found to have D-differential papillary
carcinoma on fine-needle aspiration.  The patient was also
found to have multiple pulmonary nodules on chest CT and
chest x-ray at that time, and the patient was admitted on
[**2186-9-13**] with shortness of breath and aspirate of right
lower lobe nodule at that time revealed malignant cells.  The
patient was scheduled for total thyroidectomy with the
surgery team on [**9-29**] with plan to pursue adjuvant
chemotherapy and XRT to the surgical bed.  The patient was to
receive carboplatinum and Taxol as the chemotherapeutic
regimen.  The patient had a CAT scan at that time, which
revealed multiple pulmonary nodules.  The patient presented
with progressive shortness of breath, nonproductive cough,
right sided chest discomfort.  Postoperatively, the patient
had increased hypoxia.  The patient was found to have small
PEs on CT angiogram.  The patient was heparinized and
coumadinized at that time.  The patient was started on
decadron prechemotherapy and the course was complicated by
possible pneumonia on chest x-ray.  There was no complaints
of chest pain, nausea, vomiting, abdominal pain, or pleuritic
chest pain that the patient recalls.

PAST MEDICAL HISTORY:
1.  Thyroid cancer, tissue biopsy awaiting diagnosis with
pulmonary metastasis, diagnosed by FMA as D-differentiated
papillary carcinoma versus medullary carcinoma.
2.  Multinodular goiter times 34 years.
3.  Hypertension.
4.  Non-insulin-dependent diabetes mellitus on oral
hypoglycemics.

MEDICATIONS ON ADMISSION:
1.  Glucophage b.i.d.
2.  Uniretic 25/15 q.d.

ALLERGIES:  No known drug allergies.

MEDICATIONS ON TRANSFER:  Medications upon transfer to the
medicine service were as follows:
1.  Regular insulin sliding scale.
2.  Tums 500 mg t.i.d.
3.  Albuterol nebs q.6 hours p.r.n.
4.  Levofloxacin 500 mg q.d.
5.  Levoxyl 100 mg q.d.
6.  Lopressor 50 mg b.i.d.
7.  ....................20 mg PO q.d.
8.  Protonix 40 mg q.d.
9.  Oxycodone p.r.n.
10. Morphine IV q.4h. to q.6.p.r.n.
11. Albuterol and Atrovent MDIs.

SOCIAL HISTORY:  The patient lives with her daughter.  T was
born in [**Location (un) 4708**].  The patient was a day care provider and
has three children.  The patient denies tobacco or alcohol
use.

FAMILY HISTORY:
1.  Hypertension.
2.  "Thyroid disease."
3.  No history of cancer, of which the patient is aware.

PHYSICAL EXAMINATION:  Examination upon presentation revealed
the following:  Temperature 99.1, heart rate 110,
respirations 20, 130/70, 96% on 3?????? liters.  GENERAL:  The
patient is a fairly ill-appearing female in no apparent
distress.  HEENT:  Extraocular muscles are intact.  Pupils
equal, round, and reactive to light.  No bruits.  Upon
palpation of the thyroid, tongue is midline.  Neck incision
present, palate rises symmetrically.  CARDIAC:  Normal S1 and
S2, no murmurs, rubs, or gallops.  PULMONARY:  Clear to
auscultation bilaterally.  ABDOMEN:  Soft, nontender,
nondistended, positive bowel sounds.  EXTREMITIES:  Trace
edema, vascular good peripheral pulses.  NEUROLOGICAL:  The
patient was alert, oriented and grossly intact.

LABORATORY DATA:  Labs upon admission revealed the following:
White blood cell count 24.5, hematocrit 30.2, platelet count
639,000.  Sodium 136, potassium 4.0, chloride 93, bicarbonate
30, BUN 14, creatinine 0.5, platelets 125,000, calcium 8.4,
phosphorus 3.8, magnesium 1.7, INR 2.

STUDIES:  CT angiogram revealed multiple small segmental PEs.
CT of the body revealed increased side of pulmonary nodules,
large heterogenous goiter.

HOSPITAL COURSE:  The patient was admitted to the Surgical
Service, where she had a resection of the thyroid and she was
transferred to the medical service for administration of
chemotherapy and further medical management.  While the
patient was on the Oncology Service at [**Hospital1 190**], the pulmonary status remained tenuous
initially, requiring q.4h. nebs, Albuterol and Atrovent MDIs
and Flovent MDIs, as well as aggressive chest PT.  The
patient was also placed Levaquin and Flagyl due to possible
pneumonia given low-grade temperatures, increased white blood
cell count and a chest x-ray, which was equivocable for lower
lobe atelectasis versus pneumonia.  The patient's pulmonary
status progressively improved over time and the patient was
followed very closely by the Department of Physical Therapy,
as well as the Pulmonary Therapist who believed that the
patient's standing q.4h. medications at the time of discharge
could actually be tapered down to p.r.n. since she was doing
so well.  The patient was also placed on a rapid Prednisone
taper to increase the pulmonary reserves, as well.  There was
no evidence of volume overload, and the patient was not
diuresed for reasons of CHF.

ONCOLOGY:  The patient was administered Taxol and Carboplatin
with premedication on [**10-6**] with XRT to be followed up in
three weeks.  The patient tolerated this regimen fairly well,
even though she had subsequent decrease in the hematocrit
possibly due to this chemotherapy.

From the hematologic standpoint, the patient was converted
from coumadin to low-molecular weight heparin with good
therapeutic effect for her PEs.  The patient's low-molecular
weight heparin level was 0.78 when checked and within the
therapeutic range.  The patient complained of no pleuritic
chest pain.  The patient had a negative [**Last Name (un) 4709**] sign and no
palpable cords during her admission and stay on the
Hematology Service.  The patient had guaiac time three
negative and hemolysis labs, which were negative, but the
hematocrit continued to drift downwards and eventually had to
be transfused two units of packed red blood cells.  Of note,
the patient is not a Jehovah Witness, but she was raised in
the Jehovah Witness family and held off for transfusion until
her hematocrit reached 22.  The patient was also started on
q. week Procrit and iron as well.  The patient's PT remained
high around 1.8 during the admission, which was thought to be
due to poor nutritional status and after her nutrition picked
up the INR drifted downwards to 1.1.

The patient also had hyponatremia, thought to be due to SIADH
secondary to pulmonary metastasis, which improved gradually
with the administration of salt tablets and Lasix, which were
given as a standing dose.  At the time of discharge, the
sodium was 133.  The patient had no neurological
manifestations of hyponatremia, such as decreased mental
status or confusion.  The patient, at the time of discharge,
had decreased PO intake of solid foods and remained in fluid
restriction.

From an endocrine standpoint, the patient remained on her
regular insulin sliding scale, which was adequate, even
though while she was on her Prednisone taper, the glucose
levels ran consistently around 150 to 170.

During this admission, the patient was changed over from full
code to DNR/DNI.  This was done after extensive discussion
with the hematology and oncology attending, Dr. [**Last Name (STitle) 4710**], as
well as the oncology fellow and Dr. [**First Name (STitle) 4702**], the patient's
PMD.  The patient consistently stated that she does not want
heroic measures to be taken and, therefore, change in code
status was consistent with this long-held view.  The
patient's family members were also present during her
conversations and agreed with the plan.

DISCHARGE DIAGNOSES:
1.  Metastatic thyroid carcinoma with metastasis to lung.
2.  Syndrome of inappropriate secretion of antidiuretic
hormone secondary to pulmonary metastasis.
3.  Recent PE during this admission secondary to
hypercoagulable state.
4.  Anemia secondary to chemotherapeutic agents.
5.  Hypertension.
6.  Insulin dependent diabetes mellitus.

DISCHARGE MEDICATIONS:
1.  Lovenox 70 mg subcutaneously q.12h.
2.  Protonix 40 mg PO/IV q.d.
3.  Colace 100 mg PO b.i.d.
4.  Senna two tablets PO q.h.s.
5.  Albuterol two puffs MDI q.4h.
6.  Levoxyl 100 mcg PO q.d.
7.  Tums 500 mg PO t.i.d. between meals.
8.  Lopressor 50 mg PO b.i.d.
9.  Trazodone 50 mg PO q.h.s.p.r.n.
10. Flagyl 500 mg PO t.i.d. times 7 days.
11. Levaquin 500 mg PO q.d. times 7 days.
12. Prednisone 40 mg q.d. times two more days, 20 mg q.d.
times three more days, then discontinue.
13. Flovent 110 mcg MDI four puffs b.i.d.
14. Albuterol and Atrovent nebulizers q.4h. inhaled around
the clock (this may be able to be tapered if pulmonary
function continues to be good off Prednisone).
15. Regular insulin sliding scale.
16. Lasix 20 mg PO q.d.
17. Ferrous sulfate 325 mg PO t.i.d.
18. Procrit 40,000 units q.week.
19. Dulcolax 10 mg PO p.r.n.q.d.
20. Sodium chloride one gram PO b.i.d.
21. Ibuprofen 600 mg q.4h.p.r.n.
22. Zofran 8 mg IV q.8h.p.r.n.
23. Robitussin p.r.n. cough.

DISCHARGE PLAN:
1.  The patient was to be discharged to [**Hospital3 7**] for
further management of her pulmonary complications secondary
to pulmonary metastasis.
2.  The patient was to follow up with her
hematologist/oncologist, Dr. [**Last Name (STitle) 4711**] next Tuesday at which
time it would be reconsidered if she needed further
chemotherapeutic interventions, as well as XRT.
3.  The patient was to follow up with her primary care
physician in two weeks.

CONDITION ON DISCHARGE:  Stable.


                       [**Name6 (MD) **] [**Name8 (MD) **] m.d.02-333



Dictated By:[**Name8 (MD) 4712**]
MEDQUIST36

D:  [**2186-10-13**]  10:03
T:  [**2186-10-13**]  10:42
JOB#:  [**Job Number 4713**]
{'Malignant neoplasm of thyroid gland,Secondary malignant neoplasm of other specified sites,Secondary malignant neoplasm of lung,Iatrogenic pulmonary embolism and infarction,Pneumonia, organism unspecified,Other disorders of neurohypophysis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: Metastatic thyroid cancer to the lungs.

PRESENT ILLNESS: The patient is a 53-year-old
female with a history of hypertension, non-insulin-dependent
diabetes mellitus, and a long history of multinodular goiter,
which has doubled in size recently.  The patient was admitted
on [**8-/2186**] and found to have D-differential papillary
carcinoma on fine-needle aspiration.  The patient was also
found to have multiple pulmonary nodules on chest CT and
chest x-ray at that time, and the patient was admitted on
[**2186-9-13**] with shortness of breath and aspirate of right
lower lobe nodule at that time revealed malignant cells.  The
patient was scheduled for total thyroidectomy with the
surgery team on [**9-29**] with plan to pursue adjuvant
chemotherapy and XRT to the surgical bed.  The patient was to
receive carboplatinum and Taxol as the chemotherapeutic
regimen.  The patient had a CAT scan at that time, which
revealed multiple pulmonary nodules.  The patient presented
with progressive shortness of breath, nonproductive cough,
right sided chest discomfort.  Postoperatively, the patient
had increased hypoxia.  The patient was found to have small
PEs on CT angiogram.  The patient was heparinized and
coumadinized at that time.  The patient was started on
decadron prechemotherapy and the course was complicated by
possible pneumonia on chest x-ray.  There was no complaints
of chest pain, nausea, vomiting, abdominal pain, or pleuritic
chest pain that the patient recalls.

MEDICAL HISTORY: 1.  Thyroid cancer, tissue biopsy awaiting diagnosis with
pulmonary metastasis, diagnosed by FMA as D-differentiated
papillary carcinoma versus medullary carcinoma.
2.  Multinodular goiter times 34 years.
3.  Hypertension.
4.  Non-insulin-dependent diabetes mellitus on oral
hypoglycemics.

MEDICATION ON ADMISSION: 1.  Glucophage b.i.d.
2.  Uniretic 25/15 q.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 1.  Hypertension.
2.  "Thyroid disease."
3.  No history of cancer, of which the patient is aware.

SOCIAL HISTORY: The patient lives with her daughter.  T was
born in [**Location (un) 4708**].  The patient was a day care provider and
has three children.  The patient denies tobacco or alcohol
use. 

### Response:
{'Malignant neoplasm of thyroid gland,Secondary malignant neoplasm of other specified sites,Secondary malignant neoplasm of lung,Iatrogenic pulmonary embolism and infarction,Pneumonia, organism unspecified,Other disorders of neurohypophysis,Unspecified essential hypertension,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Anemia, unspecified'}
