Case Study Thyroid Disorder
Maria is a 29-year-old woman with a seven-month history of heavy, irregular menses, a 5-lb weight gain, constipation, and decreased energy. Her past history is unremarkable. She takes no prescription medications but uses iron and calcium supplements. She has a family history of thyroid disease. On examination, her weight is 152 lbs, her heart rate is 64 bpm, and her blood pressure is 138/86. Her thyroid gland is mildly enlarged, without nodularity. She has trace edema in her lower extremities, and her reflexes are slow.
Laboratory studies are as follows:
TSH is 15.3 mIU/mL (elevated), free T4 is 0.3 mIU/mL (decreased), and total cholesterol is 276 mg/mL.
Diagnosis: Primary Hypothyroidism
1. List specific goals of treatment for Maria.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for Maria?
8. What lifestyle changes would you recommend to Maria?
9. Describe one or two drug–drug or drug–food interactions for the selected agent.
Use 3 evidence based articles and write inn APA format.
Hypothyroidism is the condition that results when the normal function of the thyroid gland disrupted to produce low thyroid hormones. Thus common symptoms associated with this condition is weight gain (normal weight of 29-year old woman = 132 lbs), high cholesterol level (normal range = 200-239 mg/dL), slowed heart rate (normal = 60-100 bps), decreased sweating, fatigue, muscle pain, irregular menstrual cycle, constipation, lack of energy, or depression. This condition can be diagnosed by the TSH test (normal range = 0.5-2.50 mIU/mL) and T3 or T4 test. Therefore, the diagnostic finds of M.E. show that she has hypothyroidism.
1. The specific goals for M.E.’s treatment includes – (i) To design weight loss management plan with proper diet, (ii) To maintain regular menstrual cycle, (iii) To bring blood pressure normal, and (iv) To increase the rate of metabolism.
2. Hypothyroidism is best treated using levothyroxine. Levothyroxine is the medication used to treat under-reactive and enlarged thyroid glands. This medication works like the natural thyroid hormones T4 (thyroxine) which is synthesized in the body and mimics its work of action to reverse the symptoms caused by hypothyroidism.
3. The effectiveness of levothyroxine is assessed by a blood test that indicates the level of thyroid hormones like T3, T4, and TSH in the body before and after it has taken. This blood test is done after 4 to 6 months and even after one year.
4. Before taking this medication the physician should know that the patient is aware that it is not prescribed for weight loss or obesity. It is prescribed to bring the thyroid hormone level normal in the body. The patient should also aware to tell if they have any other medical condition like thyrotoxicosis, heart attack, adrenal gland disorder, pituitary gland problem, kidney disease or any heart disease. Also, the patient should tell the physician whether they are pregnant or have undergone any surgery. Because this medication makes this condition even worse. The patient’s education also includes how to use the medication, that is, how this medication should be taken. First, swallow the medication with water if it is an oral tablet or using a spoon if it is in liquid form for every 30 minutes to 1 hour on an empty stomach.
5. Levothyroxine has some side effects which include increased appetite, weight loss, headache, hyperactivity, heat intolerance, muscle cramps or sickness. The most adverse condition is hyperactivity and allergic reaction. The presence of excess levothyroxine affects the brain and leads to hyperactivity or ADHD (attention deficit hyperactivity disorder). This is because the abnormal level of thyroid hormones interferes with the signal which is sent to the brain and gets mixed with the ADHD symptoms. Another reaction is an allergy, because the presence of dye or food color, magnesium stearate, talc, and alcohol triggers the immune system to produce chemical mediators that results in skin rash or hives.
6. Liothyronine sodium is the synthetic form of thyroid hormone T3 that mimics its action to regulates the body’s metabolism and energy production. This medication is most commonly used as a second-line therapy with levothyroxine for hypothyroidism. Because they control the symptoms associated with hypothyroidism by increasing the metabolic rate of the tissue and returns the level of T3 to normal.
7. Levoxyl, armour thyroid, orlistat, and laxatives are commonly used as over-the-counter medication which lowers the symptoms associated with hypothyroidism. (i) Levoxyl also replaces the function of thyroid hormone and treats other condition like goiter and thyroid cancer, (ii) Armour thyroid is a medication prepared from products of animal’s thyroid gland which also works to bring the thyroid hormone level to normal, (iii) Orlistat helps to treat obesity, and (iv) Laxatives for treatment of constipation.
8. Proper dietary plans, weight management, exercise, and stress management helps M.E. to cut the effect of hypothyroidism. (i) Proper dietary plan – It is the best way to bring the body to healthy condition by eating balanced and nutritious food like fruits, vegetables, lean meats, whole grains and supplements like calcium, Selenium, omega-3, and vitamin B6 and E, (ii) Weight management – It is essential to balance of weight which doesn’t affect the body’s normal hormone level and cut the risk of thyroid cancer, (iii) Exercise – This will increase the rate of metabolism and improves weight loss, (iv) Stress management – Meditation and Yoga offer better relieve from stress factors.
9. Carbamazepine, birth control pills, sertraline, and warfarin should not be taken along with levothyroxine or any other thyroid medications because these drugs will decrease the efficacy and effectiveness of thyroid medications. (i) Carbamazepine – This medication is an anticonvulsant which increases the rate of metabolism of levothyroxine, (ii) Birth control pills – This medication induces the binding of TBG (thyroxine-binding globulin) that in turn lowers the level of free thyroid hormone in the body, (iii) sertraline – It is an antidepressant that reduces the amount of thyroid medicine in the body, and (iv) Warfarin – It interacts with levothyroxine and cause the blood to be too thin with bleeding. Some foods like cottonseed meal, walnut, fiber, soybean flour interacts with the absorption of levothyroxine.