Question

NEED ANSWER PART 3

Kate is a 30 year old woman who just delivered her second child two weeks ago. Two weeks after her delivery, Kate comes to your office to be evaluated. She states she has been tired, weak, and has widespread joint and muscle pain. Despite the mild weather, she notes that she is cold all the time, and that instead of losing her “baby weight” she has actually gained about 15 pounds.

Kate has delivered two healthy children. She has no other medical history. It is her intention to breastfeed for at least the first 12 months. She continues to take her prenatal vitamins, and plans on having an intrauterine device placed for contraception at her six week follow up. She is a non-smoker, does not have a history of illicit drug use, and is currently abstaining from alcohol though she has consumed alcohol socially prior to her pregnancies.

Her vital signs are as follows: Height 5’4”, weight 165 lb, Heart rate slowed at 48 beats per minute, blood pressure normal at 110/56, temperature normal at 98.2℉.

Her lab work is as follows:

	Kate’s lab values:	Reference range:
	TSH: TSH 25 μU/mL	0.5-4.70 µIU/mL
	T4, total: 3 μg/dL	4.5-12.5 µg/dL
	FT4: 0.4 ng/dL	0.8-1.8 ng/dL
	T3: 80 ng/dL	80 -200 ng/dL
	Thyroperoxidase antibodies (-)	negative

Her treatment is:

• Based on laboratory results, Kate is supposed to suffer from Post partum Hypothyroidism. Since the presence of thyroperoxidase antibody is found to be negative, she is free of autoimmune disorder.
• TSH regulates the production of T4 and then conversion to T3 takes place. Increased TSH is released when there is demand by feedback mechanism due to decreased T3 and T4. This happens in hypothyroidism.
• Kate can have primary thyroid malfunction. That is why her TSH is elevated and body lacks feed back mechanism. Pituitary gland is functioning with TSH secretion, and is increased due to lack of thyroid hormone's feedback.

Rationale (part 3)

It’s time to treat Kate, and explain her treatment to her. In a half-page response, explain to Kate what type of treatment she will undergo and why. Be sure to also explain what the treatment will do for Kate’s physiology, and what you expect to happen to her lab values.

Answer 1

This is also called as postpartum thyroiditis.

The treatment for this are

• No actual treatment is required unless a patient shows severe signs and symptoms
• The thyroid levels are monitored once in a month or every three months once because this can return to normal in a period of 1 -1 1/2 year.
• Thyroid replacement hormone is indicated to replace the telephone hormone .The decreased level of T3 and T4 are increased due to the blocking of thyroid stimulating hormone .Tye level of TSH decreases with increased T3 and T4.This helps to get rid of unnecessary weight gain ,tiredness, weakness and muscle pain
• Beta blocker (Inderal) is advised to control the high TSH level.This is a safe drug because it does not passing through the breast milk. It also does the same action.
• Encourage to do post operative exercise
• Diet rich in zinc ,whole grains
• Encourage to breast feed the baby.
• Encourage to follow up as advices to monitor for prognosis .