Primary Hypothyroidism Case Study

This report analyzes a case study of a female patient diagnosed with primary hypothyroidism. It discusses the symptoms, treatment goals, prescribed drug therapy, monitoring success of therapy, patient education, adverse reactions, choice of second line therapy, over the counter or alternative medication, drug interaction, and recommendations. The report concludes that primary hypothyroidism is a treatable disease and should be kept in check easily.

Running head: PRIMARY HYPOTHYROIDISM CASE STUDY
Primary Hypothyroidism Case Study
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Executive Summary:
Hypothyroidism is a common problem seen in the United States, as of late. Many people
affected by this disease seem to unaware of its symptoms and receive substandard treatment or
sometimes no treatments at all. The main cause of hypothyroidism seen is due to an auto immune
disease called Hashimoto’s Diseases, where the patient’s thyroid gland is stimulated by thyroid
stimulating hormone, but the body fails to produce the hormones. The report is based on a case
study that shows the symptoms of a mid adult woman, who developed this disease without prior
knowledge. A treatment synopsis is contemplated to help her improve her condition.

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Table of Contents
Introduction:....................................................................................................................................3
Discussion:.......................................................................................................................................3
Treatment Goals for the patient:..................................................................................................3
Prescribed Drug Therapy:............................................................................................................3
Importance of the said Drug:.......................................................................................................4
Monitoring Success of the Therapy:............................................................................................4
Patient Education:........................................................................................................................4
Adverse Reaction of the Therapy:...............................................................................................5
Choice of Second Line Therapy:.................................................................................................5
Over the counter or Alternative Medication:...............................................................................5
Drug Interaction:..........................................................................................................................5
Recommendation:........................................................................................................................6
Conclusion:..................................................................................................................................6
References:......................................................................................................................................7

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Introduction:
Primary hypothyroidism is one of the most common hormonal diseases that affect United
States. The treatment of hypothyroidism is considered easy by practitioners, but a large number
of patients suffering from this condition are unsatisfactorily treated. Western countries suffer
from Hasimoto’s thyroiditis or due to iodine deficiency (Pellegriti et al., 2013). The aim of this
report is to analyze the case study provided about a female patient diagnosed with primary
hypothyroidism, meaning the body failed to produce the thyroid hormone even after the gland
being normally stimulated. The female patient in the case is overweight, does not undergo any
medication, and faces fatigue and irregular menstruation for the past 7 months.
Discussion:
Treatment Goals for the patient:
Hypothyroidism is usually treated by prescribing medication to the patient or by
clinically replacing the hormone in the body, depending on the assessment of the practitioner.
Treatment for hypothyroidism involves taking medication to replace the missing thyroid
hormones. The patient should be tested for a thyroid peroxidase (TPO) antibody test, to ensure
whether or not she has developed Hashimoto’s disease (Caturegli, De Remigis & Rose, 2014).
Prescribed Drug Therapy:
The best choice of drug for hypothyroidism is Levothyroxine commonly known as LT4,
which has to be taken daily (Okosieme et al., 2016). A healthy person without any heart
condition, below fifty years of age can be administered with a complete dose of the drug

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respective to their body weight (1.6 μg/kg/day). Thyroid hormone is prescribed to supplement or
replace hormonal production.
Importance of the said Drug:
Levythyroxine is the most common drug used to treat patients with hypothyroidism and
Hashimoto’s disease. The dosage is contemplated with respect to the age, sex, body weight,
cardiac output of the patient. This drugs works effectively on most people, but elderly people are
not advised to take this, as the drug interferes with heart diseases. It is advised to take the
medicine in an empty stomach with a glass full of water, but it can also be taken after meal in the
night if complications are seen.
Monitoring Success of the Therapy:
The success of the levothyroxine drug is dependent on the complete monitoring of the
patient symptoms. Prior to administering the drug, the patient needs to be tested for TSH and T4
before 4 weeks approximately (Javed, & Sathyapalan, 2016). The patient in the case study has
elevated levels of TSH (15.3 mIU/ml), but her free T4 was relatively low (0.3 mIU/ml). The
possible outcome that can be deduced from this situation is that the patient is suffering from
Hashimoto’s disease. The dosage should be adjusted according to the need of the patient and
advised to take the medication lifelong, unless signs of side effects are seen.
Patient Education:
The patient should be made aware of her condition and given appropriate instruction. The
patient has been taking iron and calcium supplements and these two supplements hinder the
absorptive mechanism of the thyroid hormone. The patient should be advised to stop taking those
supplements immediately. It is the duty of the physician to be made aware that calcium can

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prevent the absorption of thyroxin (Ishikawa, Hashimoto, & Kiuchi, 2013). The patient is also
advised to change her lifestyle and eating habits, as she has a high level of cholesterol in her
blood.
Adverse Reaction of the Therapy:
Levothyroxine has some common side effects the first few months of administration. The
possible symptoms include hair loss and uneasiness until the patient’s body gets accustomed to
the drug. The patient in the case study also showed mild symptoms and delayed response to the
drug until the effects of her iron and calcium supplements wore out. There are other possible
adverse effects are irregular menstrual cycle, insomnia, heat flashes and loss of appetite
(Burman, 2015). If these symptoms persist, alternative second line medication should be
administered.
Choice of Second Line Therapy:
Levothyroxine is suited to 85% of the affected patient. Sometimes, administration of
these drugs may have adverse effects. Some patients have been reported to have side effects
while ingesting the drug in an empty stomach. Those people are recommended to take the
medicine after meal, which does not alter its effect on TSH (Geer, Potter, & Ulrich, 2015).
Sometimes a combination of levothyroxine and Triiodothyronine can also be advised. Changing
diet or lifestyle may also help the practitioner to treat the patient.
Over the counter or Alternative Medication:
Armour Thyroid, Cytomel and Synthoid are also some alternative choices, if the patient’s
metabolism does not accept Levothyroxine.

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Drug Interaction:
A number of medications, dietary supplements, and food habits can interfere with the
absorption and action of levothyroxine (Irving, Vadiveloo & Leese, 2015). Iron supplements,
calcium supplements can affect levothyroxine absorption. Cholestyramine, a cholesterol
lowering drug is not advised to the patient even if her levels seem high. Aluminum hydroxide,
present in certain antacids should be avoided.
Recommendation:
The patient is advised to continue her medication throughout her life and replace with
other alternatives if any side effects are observed. Since the patient is presumably suffering from
Hashimoto’s disease, an autoimmune disorder, her thyroid levels will continuously need to be
checked. The patient is recommended to change her lifestyle, get more exercise to control her
cholesterol level, as Cholestyramine will interfere with her thyroid medication. The patient is
advised to immediately stop taking her iron and calcium supplements in order to avoid drug
interaction. The patient should regularly check her thyroid activity in order control TSH-T4
absorption. The patient should try to exercise, and avoid any further weight gain, as that might
lead to cardiac diseases. The patient is advised to monitor her menstrual cycle after initial
adjustment period is over. If adverse symptoms persist, she should inform the doctor to change
her medication. Over expression of Iodine, could be the reason for the thyroid gland swelling.
Conclusion:
Primary hypothyroidism is a very treatable disease and could be kept in check easily.
Most affected people do not realize the root of the problem, as seen in the situation of the
provided case study. She developed Hashimoto’s disease and kept on taking iron and calcium
supplements, which worsened her health. The patient is advised to continue her medication

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throughout her life. The United States population should be made of the clinical symptoms, as
more and more people are being affected by it.

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References:
A Irving, S., Vadiveloo, T., & Leese, G. P. (2015). Drugs that interact with levothyroxine: an
observational study from the Thyroid Epidemiology, Audit and Research Study
(TEARS). Clinical endocrinology, 82(1), 136-141.
Burman, K. D. (2015). Introduction. In A Case-Based Guide to Clinical Endocrinology (pp. 121-
125). Springer, New York, NY.
Caturegli, P., De Remigis, A., & Rose, N. R. (2014). Hashimoto thyroiditis: clinical and
diagnostic criteria. Autoimmunity reviews, 13(4-5), 391-397.
Geer, M., Potter, D. M., & Ulrich, H. (2015). Alternative schedules of levothyroxine
administration. American Journal of Health-System Pharmacy, 72(5), 373-377.
Ishikawa, H., Hashimoto, H., & Kiuchi, T. (2013). The evolving concept of “patient-
centeredness” in patient–physician communication research. Social Science &
Medicine, 96, 147-153.
Javed, Z., & Sathyapalan, T. (2016). Levothyroxine treatment of mild subclinical
hypothyroidism: a review of potential risks and benefits. Therapeutic advances in
endocrinology and metabolism, 7(1), 12-23.
Okosieme, O., Gilbert, J., Abraham, P., Boelaert, K., Dayan, C., Gurnell, M., ... & Williams, G.
(2016). Management of primary hypothyroidism: statement by the British Thyroid
Association Executive Committee. Clinical endocrinology, 84(6), 799-808.

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Pellegriti, G., Frasca, F., Regalbuto, C., Squatrito, S., & Vigneri, R. (2013). Worldwide
increasing incidence of thyroid cancer: update on epidemiology and risk factors. Journal
of cancer epidemiology, 2013.