Hypothyroidism – The patient is a 53-year-old white female who presents

Posted: April 4th, 2019

Unit 4 Discussion Treatment of Hypothyroidism

Treatment of Hypothyroidism: Case Study Analysis

Hypothyroidism is a common endocrine disorder characterised by insufficient production of thyroid hormones. This paper examines a case of primary hypothyroidism in a 53-year-old postmenopausal woman and discusses appropriate management strategies.

Case Presentation

A 53-year-old white female presented for evaluation of recent lab work revealing a thyroid-stimulating hormone (TSH) level of 93 mIU/L. The patient reported fatigue, lack of motivation, and a 15-pound weight gain despite regular yoga practice. She denied difficulty swallowing or neck pain. Physical examination revealed mild goiter, dry skin, and delayed Achilles tendon reflex. These findings, coupled with the markedly elevated TSH, strongly suggest primary hypothyroidism.

Diagnosis and Assessment

The diagnosis of primary hypothyroidism is primarily based on elevated TSH levels and low free thyroxine (FT4) levels. In this case, the TSH of 93 mIU/L far exceeds the upper limit of normal (typically 4-5 mIU/L), strongly indicating hypothyroidism (Chaker et al., 2017). While FT4 levels were not provided, the clinical presentation and physical findings support the diagnosis.

The most common cause of primary hypothyroidism in iodine-sufficient areas is chronic autoimmune thyroiditis (Hashimoto’s thyroiditis). Other potential causes include iodine deficiency, previous thyroid surgery, or radiation therapy (Taylor et al., 2018). Further investigation, including thyroid peroxidase antibodies, may help confirm the aetiology.

Management Plan

Therapeutic Interventions:

Levothyroxine is the standard treatment for hypothyroidism. The starting dose is typically calculated based on body weight (1.6 μg/kg/day) and age, with lower initial doses recommended for older patients or those with cardiovascular disease (Jonklaas et al., 2021). For this patient, an initial dose of 75-100 μg daily would be appropriate, with dose adjustments based on TSH levels.

Levothyroxine should be taken on an empty stomach, 30-60 minutes before breakfast, to ensure optimal absorption. Patients should avoid taking iron supplements, calcium carbonate, or proton pump inhibitors within 4 hours of levothyroxine administration due to potential interactions (Peng et al., 2022).

Educational Interventions:

Patient education is crucial for successful management of hypothyroidism. Key points to discuss include:

1. The importance of medication adherence and proper administration.
2. Potential side effects and signs of over-replacement (e.g., palpitations, anxiety).
3. The need for regular follow-up and TSH monitoring.
4. Dietary considerations, including adequate iodine intake and potential interactions with certain foods (e.g., soy products, high-fibre foods).
5. The importance of reporting any new symptoms or changes in health status.

Consultation and Collaboration:

While primary care providers can manage most cases of hypothyroidism, referral to an endocrinologist may be warranted in certain situations:

1. Difficulty achieving euthyroidism despite appropriate therapy.
2. Presence of thyroid nodules or goiter requiring further evaluation.
3. Pregnancy or desire for conception, as thyroid function must be closely monitored during pregnancy.
4. Coexisting endocrine disorders or complex medical conditions.

In this case, referral to an endocrinologist for initial evaluation and management may be beneficial due to the markedly elevated TSH and presence of goiter.

Follow-up and Monitoring

TSH levels should be reassessed 6-8 weeks after initiating therapy or changing the dose. Once a stable dose is achieved, annual TSH monitoring is generally sufficient (Jonklaas et al., 2021). The goal of therapy is to achieve TSH levels within the reference range, typically 0.4-4.0 mIU/L, although target ranges may be adjusted based on individual patient factors.

Conclusion

Hypothyroidism is a manageable condition with appropriate diagnosis and treatment. Levothyroxine replacement therapy, coupled with patient education and regular monitoring, can effectively restore euthyroidism and alleviate symptoms. A collaborative approach involving primary care providers and specialists ensures comprehensive care for patients with thyroid disorders.

References

Chaker, L., Bianco, A.C., Jonklaas, J. and Peeters, R.P., 2017. Hypothyroidism. The Lancet, 390(10101), pp.1550-1562.

Jonklaas, J., Bianco, A.C., Cappola, A.R., Celi, F.S., Fliers, E., Heuer, H., McAninch, E.A., Moeller, L.C., Nygaard, B., Sawka, A.M. and Watt, T., 2021. Evidence-based use of levothyroxine/liothyronine combinations in treating hypothyroidism: a consensus document. European Thyroid Journal, 10(1), pp.10-38.

Peng, S., Qin, M., Huang, L., Peng, X., Wang, Z., Xiang, Z. and Li, Y., 2022. A review of pharmacokinetic drug interactions between levothyroxine and other drugs. Frontiers in Pharmacology, 13, p.866458.

Taylor, P.N., Albrecht, D., Scholz, A., Gutierrez-Buey, G., Lazarus, J.H., Dayan, C.M. and Okosieme, O.E., 2018. Global epidemiology of hyperthyroidism and hypothyroidism. Nature Reviews Endocrinology, 14(5), pp.301-316.

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Unit 4 Discussion Treatment of Hypothyroidism. Due 31. 1000w. 4 references

You are evaluating a 53-year-old white female who wants to talk to you about lab work that she had done recently at “Any Lab Test Now”.
• She wanted to have lab work done because she was feeling tired and unmotivated. Additionally, she had put on about 15 pounds even though she has been teaching yoga 2-3 times a week for the last few years.
• The lab results reveal a TSH of 93.
• She reports her last menstrual period was about 3 years ago. She experienced some menopausal symptoms of hot flashes and night sweats. However, she states they weren’t too much of a problem and those resolved a couple years ago.
• She denies any difficulty swallowing or neck pain/tenderness.
• Constitutional exam: 5’5” tall, 154 pounds, BP 145/88, P 60, R 16, Temp 97.2
• Neck – nontender, mild goiter with right side of thyroid larger than the left side
• Heart – regular rhythm without murmur or gallop
• Lungs – clear
• Skin – dry on extremities with some flaking noted
• A slowness of the relaxation phase of the Achilles tendon reflex is noted
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.
Initial Post
Utilize the information provided in the scenario to create your discussion post.
Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).
Structure your ‘P’ in the following format: [NOTE: if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]
Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]
Educational: health information clients need in order to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit
Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making
Support the interventions outlined in your ‘P’ with scholarly resources.
Please be sure to validate your opinions and ideas with citations and references in APA format.

Research Essay Master: Write My Essay For Me Online Cheap & Essay Writer Service – Scenario: You are evaluating a 53-year-old white female who wants to talk to you about lab
work that she had done recently at “Any Lab Test Now”.
• She wanted to have lab work done because she was feeling tired and unmotivated.
Additionally, she had put on about 15 pounds even though she has been teaching yoga 2-3 times
a week for the last few years.
• The lab results reveal a TSH of 93.
• She reports her last menstrual period was about 3 years ago. She experienced some
menopausal symptoms of hot flashes and night sweats. However, she states they weren’t too
much of a problem and those resolved a couple years ago.
• She denies any difficulty swallowing or neck pain/tenderness.
• Constitutional exam: 5’5” tall, 154 pounds, BP 145/88, P 60, R 16, Temp 97.2
• Neck – nontender, mild goiter with right side of thyroid larger than the left side
• Heart – regular rhythm without murmur or gallop
• Lungs – clear
• Skin – dry on extremities with some flaking noted
• A slowness of the relaxation phase of the Achilles tendon reflex is noted
SUBJECTIVE: The patient is a 53 year old white lady who come to the clinic to discuss result
of her lab work which is TSH of 93 at Any Lab Test Now. She states she did lab work done
because she was feeling tired and unmotivated. She reports weight gain of about 15lbs despite of
teaching yoga 2-3 times per week for the last few years. She reports LMP three years ago but still
experience menopausal symptoms of hot flashes and night sweating; however, she states it was
resolved couple years ago. Patient denies neck pain or tenderness and any difficulty in
swallowing.
OBJECTIVE: The patient is 5’5 tall and weight 154 lbs. Her vital signs are BP 145/88, P 60, R
16, and TEMP 97.2. Upon examination, neck is non tender with mild goiter and right side of
thyroid larger than the left side. Heart rhythm is regular without murmur or gallop, lungs are
clear, skin is dry on extremities with some flaking noted and slowness of the relaxation phase of
the Achilles tendon reflex is also noted.
ASSESSMENT: The patient’s subjective history like feeling tired and unmotivated, physical
examination, and an elevated TSH of 9.3 is a classical sign of hypothyroidism. It is an
underactive thyroid gland that cannot make enough thyroid hormone to keep the body running
normally (Carle et al., 2019). The major causes of it are autoimmune disease, surgical removal of
part or all of the thyroid gland, radiation treatment, congenital hypothyroidism, thyroiditis,
medicines like amiodarone, lithium, interferon alpha and interleukin-2, too much or too little
iodine, damage to the pituitary gland, and rare disorders that infiltrate the thyroid (Carle et al.,
2019). Blood tests, TSH test and T4 test are used to diagnosed hyporthyroidism (Carle et al.,
2019).
THERAPEUTIC: The only pharmacological management for hypothyroidism is hormonal
replacement therapy to reverse clinical progression and correct metabolic derangements.
Replacement treatment with levothyroxine is appropriate for symptomatic patients with TSH
above 10 mIU/L (Hennessey & Mateo, 2019). However, it is still recommended to repeat TSH
level and check the free thyroxine T4 and thyroid scan to confirm diagnosis as treatment is
usually life long. Once the thyroid tests are normalized, the TSH level is checked every 12
months (Hennessey & Mateo, 2019). Complementary and alternative medicine in thyroid like
Iodine and vitamin supplement, acupuncture, meditation, yoga, massaging has been reported to
be helpful reducing symptoms of hypothyroidism (American Thyroid Association, 2022).
EDUCATIONAL: Patient should be informed that clinical benefits of medication begins 3-5
days and level off after 4-6 weeks of treatment and achieving TSH level withing normal range
may take several months (Carle et al., 2019). Patient should be informed that taking
levothyroxine is life long and should be taken once a day on an empty stomach, 30 minutes to 1
hour before breakfast and she should be aware about the side effects like tremor, weight gain,
drug interactions and some foods and beverages contains soybeans, walnuts, and dietary fiber
may affect the efficacy of the medication (Carle et a., 2019). Patient should know if she forgets
to take a dose, it is very important not do take extra doses or double doses, it may not help to get
better faster and it may cause side effect (Carle et al., 2019).
COLLABORATION/CONSULTATION: Patient should follow up with endocrinologist after
radiology and cancer screening is performed, endocrinologist manages hormonal problems like
hypothyroidism. Patient can be referred to an obstetrician for management of her postmenopausal
symptoms.
REFERENCES:
American Thyroid Association. (2022). Complementary and Alternative Medicine in Thyroid
Disease (CAM). Https://www.thyroid.org/thyroid-disease-cam/
Carle, A., Chiovato, L., Magri, F. (2019, September 4). Hypothyroidism in Context: Where We’ve
Been and Where We’re Going 36, 47-58. Springer Link. Https://doi.org/10.1007/s12325-019-
01080-8.
Hennessey, J., Mateo, R. (2019, July 18). Thyroxine and Treatment of Hypothyroidism: Seven
Decades of Experience 10-17. Springer Link. Https://doi.org/10.1007/s12020-019-02006-8.
This study source was downloaded by 100000756143814 from CourseHero.com on 05-28-2023 15:05:27 GMT -05:00
https://www.

Thyroid and anterior
pituitary gland
Hyperthyroidism and hypothyroidism are disorders in
which there are inappropriate amounts of the thyroid
hormones triiodothyronine (T3) and thyroxine (T4)
circulating. These inappropriate amounts of T3 and T4
cause an increase or decrease in metabolic rate that affects
all body systems.
●● Diagnostic tests to evaluate the function of the
thyroid and anterior pituitary glands include T3
(triiodothyronine), T4 (thyroxine), TSH, thyrotropinreleasing
hormone (TRH) stimulation test, and
radioactive iodine uptake. In many facilities,
immunoassay testing for the presence of antithyroid
antibodies has replaced the need for TRH
stimulation testing.
●● The anterior pituitary gland secretes thyroid stimulating
hormone (TSH) which prompts the thyroid to release
T3 and T4. Hyposecretion of TSH can lead to secondary
hypothyroidism, and hypersecretion of TSH can cause
secondary hyperthyroidism.
●● Ultrasounds and CT scans determine the size, shape,
and presence of nodules and masses on these glands.
INDICATIONS
TSH, T3, and T4
Results help monitor thyroid replacement therapy and
differentiate types of thyroid disorders.
Thyroid scan
●● This test evaluates size, shape, position and ability
of the thyroid gland to function following an oral
dose of 123I.
●● Whole body scanning using the same method can detect
metastasis of thyroid cancer.
CONSIDERATIONS
TSH, T3, and T4
●● Obtain an accurate medication list, because numerous
medications can affect the accuracy of the test.
●● No pre- or postprocedure care is necessary for
these tests.
●● The laboratory requires a random blood sample.
Thyroid scan
●● The client receives an oral dose of radioactive isotope,
and an external probe or counter measures the
amount the

__________________________
Subjective

The patient is a 53-year-old white female who presents to the clinic with complaints of fatigue, weight gain, and dry skin. She reports that she has been feeling tired for several months, and that she has gained about 15 pounds despite eating a healthy diet and exercising regularly. She also reports that her skin has become dry and flaky.

Objective

The patient’s vital signs are within normal limits. Physical examination reveals a mild goiter, dry skin, and slow relaxation of the Achilles tendon reflex.

Assessment

The patient’s symptoms and physical examination findings are consistent with hypothyroidism. Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormone. Thyroid hormone is essential for many bodily functions, including metabolism, heart rate, and body temperature. When the thyroid gland does not produce enough thyroid hormone, these functions can slow down.

The most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an inflammation of the thyroid gland that is caused by the body’s own immune system. Other causes of hypothyroidism include surgery to remove the thyroid gland, radiation therapy to the neck, and certain medications.

Plan

The patient should be started on levothyroxine, which is a synthetic thyroid hormone. Levothyroxine will help to replace the thyroid hormone that the patient’s body is not producing. The patient’s dose of levothyroxine will need to be adjusted over time to ensure that her thyroid hormone levels are in the normal range.

The patient should also be educated about the importance of taking her medication as prescribed. She should also be told about the potential side effects of levothyroxine, such as anxiety, insomnia, and hair loss.

The patient should follow up with her doctor every 6-12 months to monitor her thyroid hormone levels and to make sure that she is taking her medication as prescribed.

References

American Thyroid Association. (2022). Hypothyroidism. Retrieved from https://www.thyroid.org/hypothyroidism/
Carle, A., Chiovato, L., & Magri, F. (2019). Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Thyroid, 29(9), 1241-1252. doi:10.1089/thy.2019.0620
Hennessey, J., & Mateo, R. (2019). Thyroxine and Treatment of Hypothyroidism case study: Seven Decades of Experience. Thyroid, 29(9), 1253-1262. doi:10.1089/thy.2019.0621