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Possible Causes 1. Vitamin D deficiency – can cause diffuse musculoskeletal pain, proximal muscle weakness, bone pain. 2. Iron deficiency anemia / Hypothyroidism – common in young females; both can cause cold intolerance and generalized body pain/fatigue. 3. Peripheral vascular issues / neuropathy – less likely at her age, unless comorbidities. 4. Other deficiencies – calcium, vitamin B12, magnesium. --- 🧪 Recommended Basic Workup Serum Vitamin D (25-OH) (already known low) Serum Calcium, Phosphate, ALP CBC (to rule out anemia) TSH, Free T4 (to check hypothyroidism) Serum Vitamin B12 --- 💊 Management (General) Rx (example, to be tailored after labs): Tab. Cholecalciferol (Vitamin D3) 60,000 IU once weekly for 8 weeks, then monthly × 6 months Tab. Calcium carbonate + Vitamin D3 (500 mg elemental calcium + 250 IU Vit D3) once or twice daily with meals Analgesic (SOS): Tab. Paracetamol 650 mg TDS after meals if pain is severe Encourage sunlight exposure (20–30 min/day) Nutrient-rich diet: milk, curd, eggs, fish, nuts If anemia → add iron If hypothyroidism → levothyroxine (after confirmation) --- 👉 Since she also has cold intolerance, hypothyroidism must be ruled out (very important, not only Vit D issue).

1. Tab. Cholecalciferol 60,000 IU – 1 tab once weekly × 8 weeks, then 1 tab monthly. 2. Tab. Calcium carbonate 500 mg + Vitamin D3 – 1 tab twice daily after meals. 3. Tab. Paracetamol 500 mg – SOS for pain (max 3/day). 4. Sunlight exposure – 20–30 min daily (morning/evening). 5. Diet – Milk, curd, cheese, eggs, fish, nuts, green vegetables. 6. Investigations – CBC, TSH, Vit B12, Serum Calcium, Vit D (repeat after 8–12 weeks). Advice: Regular exercise, adequate hydration, follow-up after 2 months.

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