metabolic syndrome with diabetes and hypothyroidism

Chief complaints:
Patient presented with a chief complaints of backpain with burning micturition and less urine output
C/o diabetes since 15 years 
C/o hypertension
C/o hypothyroidism

History of presenting illness:
Patient was apparently asymptomatic 20days back then she developed back pain (dragging and pricking type of pain ) with less urine output , difficulty in voiding out urine 
H/o burning micturition
H/o cough since 20 days
H/o Fever since 3 days ( on and off onset ) , intermittent fever 
Not associated with chills and rigor
H /o acidity 
H/o headache 
H/o blurring of vision ( cataract)
H/o pedal edema (pitting type)
H/o abdominal distension 

Negative history:
No h/o palpitations
No h/o chest pain
No h/o asthma 
No h/o cad

Past history:
Diabetes since 15 years ( insulin 20 units) in the morning and also takes tablets for diabetes
C/o hypertension
C/o hypothyroidism since 5 yrs
Generalized swelling since 10 to 15 yrs

General examination:
Pallor: yes
Obese individual
Temperature:96.7c/f
Pulse rate:71 /min
Blood pressure:100/60mm /hg
Weight: 75 kgs
Oedema of feet: yes
No icterus
No clubbing of fingers
No cyanosis
C/o of parotid gland swelling ( parotitis)

Systemic examination:
ABDOMEN:
Shape of abdomen:distended
Abdominal fullness 
Bowel sounds were heard
Liver and spleen are not palpable
parotid gland swelling( parotitis)
With prominent acanthosis nigricans
Treatment:
x ray: ( pa view)

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