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

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.

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 thyroid absorbed. Areas where the isotope

was absorbed are noted as hot or warm and areas of

decreased absorption as cold.

●● Pregnancy and recent exposure to iodine-containing

dye are contraindications. Thyroid or iodine-containing

medications must be withheld for 6 weeks prior

to testing.

●● Explain to the client that the radioactive substance has

a very short half life, thus radiation precautions are not

necessary for this test unless high doses are required.

INTERPRETATION OF FINDINGS

T3 and T4

●● Low and high levels of each indicate hypothyroidism

and hyperthyroidism, respectively.

●● A high level of T3 is a better indicator hyperthyroidism

than is T4.

EXPECTED REFERENCE RANGE

●● T3: 70 to 205 ng/dL in adults ages 20 to 50

◯◯ 40 to 180 ng/dL in clients older than 50

●● T4 (total): 4 to 12 mcg/dL up to 60 years old

◯◯ 5 to 11 mcg/dL over 60 years old

TSH

●● An increased value indicates primary hypothyroidism

due to thyroid dysfunction or thyroiditis.

●● A decreased value indicates hyperthyroidism (Graves’

disease) or secondary hypothyroidism (due to pituitary

or hypothalamus dysfunction).

EXPECTED REFERENCE RANGE: 0.3 to 0.5 mU/L

Thyroid scan

●● Non-functioning areas of the thyroid can indicate

the presence of lymphoma, thyroiditis, a cyst, or

other carcinoma.

●● Functioning thyroid nodules can also represent toxic

goiter or a benign adenoma.