Question

M.E. is a 29-year-old woman with a 7-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, and total cholesterol is 276 mg/mL.

Diagnosis: Primary hypothyroidism

Answer the following questions. Include two references, cited in APA style.

List specific goals of treatment for M.E.

What drug therapy would you prescribe? Why?

What are the parameters for monitoring the success of the therapy?

Discuss specific patient education based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause you to change therapy.

What would be the choice for second-line therapy?

What over-the-counter and/or alternative medications would be appropriate for M.E.?

What lifestyle changes would you recommend to M.E.?

Describe one or two drug–drug or drug–food interactions for the selected agent.

Answer 1

●The specific goal of the treatment is to bring her thyroid hormone level to the normal range.

To control her triglyceride level to prevent cardiovascular disease

To maintain her blood pressure in normal range

●Levothyroxine is the drug which will be administered to the patient.This will increase the thyroid function to release adequate T3 and T4 levels.

●Some of the parameters to monitor the success of the therapy is

To monitor the thyroid level in 6weeks to 2 months to know the effectiveness of the drug and plan for maintenance therapy

The patient should lead a active life without any fatigue,gastrointestinal disease,with adequate energy ,normal bowel pattern

●The patient education are

• Should take the medication in early morning in empty stomach
• Avoid strong tea or coffee immediately
• Do not skip the medication and if skipped and started the routine activities of eating the day take the medicine the next day
• To check the thyroid level once in six montgs to assess the level and pkan for maintenance dose
• Do not stop medication when feeling better,because the symptoms relapses in severe extent after this
• Do not take along with other medications

●Adverse reactions are

• Head a he,nervous,anxiety,irritable
• Increased appetite,diarrhoea
• Weight loss
• Heat intolerance,excessive sweating
• Muscle spasm ,brittle nails and hair

●When first line drug therapy fails usually a second line drug therapy is initiated .The drug used here is Liothyronine

●Probiotics can be used to treat the gastrointestinal problem and certain symptoms of hypothyroidism

●Life style changes like diet modifications ,stress relievers, proper exercises sugar free diet ,medication to be taken to help maintaining normal levels.

●Anatacods,iron supplements, antibiotics interact with the drug

Foods like soybean ,cottonseed meal,walnut interact with the drug