Endocrine – 2
You are working in a community outpatient clinic where you perform the intake assessment on R.M., a 38 year old woman who is attending graduate school and is very sedentary. Her chief complaint is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. She reports a recent weight gain of 15 pounds over 2 months without clear changes in her dietary habits. Her face looks puffy, she has experienced excessive hair loss, and her skin is dry and pale. She complains of generalized body aches and pains with frequent muscle cramps and constipation. You notice she is dressed inappropriately warmly for the weather.
BP 142/84 mmHg
HR 52 beats/minute
RR 12 breaths/minute
Temperature 96.8F (36C)
Laboratory Test Results:
Thyroid-stimulating hormone (TSH) 20.9 mu/l (2-10mu/L)
Thyrotropin-releasing hormone (TRH) 18.8 ng/dl (2-10/ng/dl)
T3 24 mu/l (70-205 ng/dl)
Free T4 0.2 ng/dl (0.8-2.4 ng/dl)
1. Interpret R.M.s laboratory results
2. The practitioner affirms a diagnosis of hypothyroidism. With this diagnosis, what other signs and symptoms would you want to assess for in R.M.?
3. What general teaching issues will you address with R.M. concerning hypothyroidism?
4. What teaching needs will your review with R.M. with regard to her medication?
5. What should you teach R.M. regarding prevention of myxedema coma?
6. Which statements indicate R.M. understands your teaching regarding hypothyroidism and using Synthroid?
a. “it may take several weeks before I feel better.”
b. The best time to take my medicine is with breakfast”.
c. If my heart rate is over 100, I will hold my medication until it is back below 100″.
d. “I will be able to discontinue my medication after the symptoms are under control”
e. “I will come in when you need me to so my blood levels can be checked to make sure the medicine is working”
7. Before R.M. leaves the clinic, she asks how she will know whether the medication is “doing its job”. Outline simple expected outcomes for R.M.
8. A few weeks later, R.M. calls the clinic stating she cannot remember whether she took her thyroid medication. What additional data should you obtain, and how would you advise her?