The widely used definition of Case Based Reasoning (CBR) is similar cases of a certain problem has related solutions. Likewise, it is widely assumed that similar differences among case descriptions imply similar differences among their solutions. In this case, CBR looks to be a best solution to many unresolved medical questions and medical knowledge based systems, like in the case of hypothyroidism treatment. The main challenge, however, in finding the best solution in treating hypothyroidism with the exact dosage of levothyroxine therapy is each case is unique and difficult to derive conclusions from the previous cases (reasons). Some researches imply that case based reasoning through adaptation has a challenge in treating hypothyroidism. Nevertheless, CBR would be successful if the adaptation issue is solved. Adaptation is one of the most problematic steps in the design and development of case-based reasoning (CBR) systems. Recently, some researches have been done and scientific discussions are emerging to solve the adaptation issue. So, in this paper, I would discuss the role of adaptation in the design and development of case-based reasoning in treating hypothyroidism as well as assess the recently emerged CBR adaptation techniques and their implication to the hypothyroid treatment.

1. Knowledge Management for Health Informatics
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2. What is Hypothyroidism
Biochemical and physiologic complex

when inadequate serum levels of thyroid
hormone are present.
• Common disorder
• Synthroid one of most commonly prescribed
drugs in Canada
• Seven million prescriptions last year
• Rising at 12% per year
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3. Incidence
Congenital 1 : 5000 births

 Under age 20 1 : 1500
 Over age 20 1 : 150
 Over age 60 1 : 50
 Male / female 1:5
Basal metabolic rate can fall as low as 40 %

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4. Differential diagnosis
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5. Signs and Symptoms
 Dry skin
 Weight gain with decreased appetite / weakness
 Reflexes depressed
 Hoarseness / hair loss / hypotension
 Thick hair with loss of lateral eyebrow hair
 Puffiness of face, proximal muscle weakness
 Constipation
 Intolerance to cold
 Bradycardia
Tongue enlarged – macroglossia

 Menorrhagia or Amenorrhea
 Obese
 Hypercholesterolemia, Hyperprolactinemia
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6. Hypothyroidism and Depression
Both have in common

 So, this depression and other complication
should be treated by:
 Choice of medication
 Adjustment of Therapy
 Follow-up care
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7. Hormones for Treatment
Maintain metabolic homeostasis by

regulating:
 Intermediary metabolism
 Body weight
 Oxygen requirements
 Body temperature
control of growth, reproduction and

differentiation
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8. Some of the Problems:
Actual content of thyroid hormone varies

considerably from manufacturer to
manufacturer and even within product.
 Patients switched from one product to
another showed insignificance variations in
thyroid function
 Life long Treatment – Needs to be
monitored continuously for better treatment
results
 Thus, we need to solve this treatment
problem
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9. How do we solve these
problems?
By remembering how we solved a similar

problem in the past
In other words, Case Based Reasoning

(CBR)!
 memory-based problem-solving (Retrival)
 re-using past experiences
Experts often find it easier to relate stories

about past cases than to formulate rules
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10. CBR Solving Problems
Solution
Review
Retain
Adapt
Database
Retrieve
Similar
New
Problem
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11. CBR Assumption
New problem can be solved by

 retrieving similar problems
 adapting retrieved solutions
Similar problems have similar solutions

P P P
? PP
P PP
P
S
SX S
S S
SS S S
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12. The Challenge of Adaptation in
Medicine
Cased-Based Reasoning seems to be a

suitable technique for medical
knowledge based systems. However,
the adaptation task is “the bottleneck”
that has to be solved
 Every body is unique
 Which patient with how much dose and
how it can be treated.
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13. One of the greatest limitations of the

CBR and its system is its close
relationship with the kind of problem to
be solved. This proximity to the problem
found also in how information is
represented in the case base.
 In Medicine, solutions have to be
absolutely correct
 Many details and complex features
(interactions, exceptions, contradictions)
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14. The Cycle of Hypothyroid CBR
Problem-Solution
Solution
Review
Retain
Here we go!
New solution….
What kind of
Adapt
patients treated with
Database which does and what
special prescription
Similar problem
to similar solution,
Retrieve but take uniqueness
into account
New Patients who got solutions
with similar problem
Problem
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15. The Possible Adaptation for
Hypothyroidism
Abstraction and Hypothyroidism (In form

of Guidelines)
 Constraints and Hypothyroidism (For
Initial Therapy)
 Compositional Adaptation and
Hypothyroidism (Especially for dose
calculations)
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16. Issue of Representation
XML has become the standard for data

and document delivery on the web
 Cross-platform and extensible
 It is well supported and there is a large
toolset of XML technologies
 XML parsers, XML Schema, XML
transforms, stylesheets and more
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17. CBML Document Hierarchy
CBML schema Case structure Case content
document (XSL) document (XML) document (XML)
•The CBML (XML-based Case Mark-Up
Language) Schema document
An XML Schema document describing the syntax
of the case structure document
Static, globally available document
•The Case Structure document
•The Case Content document
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18. Case Representation
feature-value representation

 Example
case
problem solution extra info
tablet
drug filler binder lubricant disintegrant surfactant
properties
dose
excipient
excipient
excipient
excipient
excipient
amount
amount
amount
amount
amount
physical
chemical properties YP SRS
properties
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37
feature #
Problem
n
- Extra Weight
Solution
n
- Increase Thyroxin
amount
Further Patient History
n
- Diet
- Exercise © Abel M. Gebreyesus HINF 6230 18

19. What we need:
 Increased physical activity
 Increased diuresis and reduced oedema
 Decreased sensitivity to cold
 Body temp returns to normal
 Improvement in appetite and bowel activity
 Weight loss
 Improved mental alertness
 Improved speech
 Return to normal menstrual pattern
 Gradual changes to hair, skin, nails
 Improvement in anaemic state
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20. References:
Susan Craw; Case Based Reasoning; Advanced Knowledge

Based Systems Module CM4023; The Robert Gordon University,
Aberdeen
Joy Ziradkar / Carl Robbins; Hypothyroidism; MUN FP Academic

Half Day
(www.med.mun.ca/familymed/downloads/Hypothyroidism.ppt)
http://www.aanp.org/NR/rdonlyres/ewl4urqa4x5pletxro3a75q5utpp2

nngbhnezojbttcry3kj3ayj5sunjnos6q4ckmuhgddmkl6nve/4%252e5
%252e38p1.pdf
JOHN SLATOSKY, BENJAMIN SHIPTON, and HANEY WAHBA;

Thyroiditis: Differential Diagnosis and Management: American
Family Physician: Vol. 61/No. 4 (February 15, 2000)
Lorcan Coyle, Conor Hayes, Pádraig Cunningham; Representing

Cases for CBR in XML
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21. QUESTIONS????
THANK YOU!!!
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