Question

M.E. is a 42 year-old woman with an 8-month history of heavy and irregular menses, a 10-pound weight gain, constipation, and decreased energy. Her PMHx is unremarkable. She takes no medication but uses an OTC multivitamin. She has a family history of endocrine disorders. Her labs show the following: T4 low/TSH high, CBC WNL. She is diagnosed with hypothyroidism.

a. What drug therapy will you prescribe and at what starting dose

b. List specific patient education you will discuss with M.E. (S/S hyperthyroidism that may result from too high a dose of med or continued hypothyroidism, how to take the drug prescribed). 5 pts

c. Are there any OTC or CAM agents M.E. should avoid? Why?

Answer 1

aLevothyroxine is the drug of choice for hypothyroidism.In the young and otherwise healthy patient ,the maintenance replacement dose is adjusted according to the patients response and laboratory findings.

b

• Patient and family must understand the importance of thyroid replacement therapy.it ois especially important to emphasize the need for life long replacement ,the need to continually take the medication,and the need for regular follow-up care.Self -care practices to prevent complicationa= shouild also be emphasized .
• Emphasize the need for a comfortable ,warm environment because of intolerance to cold.
• Teach measures to prevent skin breakdown.
• Caution the patient,especially older adults ,to avoid sedatives.if they must must be used ,suggest that the lowest dose to be used.
• Family members should closely monitor mental status,level of consciousness and respirations.

c For minor thyroid symptoms,OTC medication may offer help,if its taken correctly .if thyroid symptoms continue while she is taking OTC medications ,it indicates that the condition isnt being treated adequately.