An obese patient, age 45, comes to your office. She recently moved from another state three weeks ago and told you that her FNP diagnosed her with type 2 diabetes mellitus. She is currently not on any medicine for her diabetes, and she wishes to avoid insulin if possible. She is a non-smoker. Her blood pressure is 138/74 mmHg. Labs from 3 weeks ago were hemoglobin A1C = 8.4%; total cholesterol = 260 mg/dL, triglycerides = 290 mg/dL, HDL = 49 mg/dL, LDL = 170 mg/dL (calculated 10-year ASCVD risk = 6.2%). You discuss current treatment goal recommendations endorsed by the ADA regarding glycemic control, blood pressure control, and lipid management. She agrees to start any medications you recommend with lifestyle modification and a DASH diet to treat hypertension.

The treatment of choice for hypothyroidism is Levothyroxine (Chiovato et al., 2019). It is mainly marketed under Synthroid, Levoxyl, and Levo T. Levothyroxine works as a synthetic T4 hormone, therefore replacing the low levels of endogenously produced T4 due to reduced thyroid gland function. Once administered, Levothyroxine is activated into triiodothyronine (T3), which is critical in regulating metabolism and production of hormones for growth and development. The initial dose will include levothyroxine 25mcg, which is to be taken orally once daily in the morning.

Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

Thyroid replacement therapy can cause adverse effects, including hyperthyroidism and associated symptoms such as increased heartbeat, heart problems, anxiety, and loss of weight (Kalra et al., 2019). It can also cause osteoporosis. The patient will be educated on the therapy’s risks, medication safety, how to self-administer the therapy, the need for consistent administration of medication, any unexpected symptoms during the therapy, and foods and medications to avoid during the therapy.

 References

Adriana Stoica, R., Simona Ștefan, D., Rizzo, M., Iulia Suceveanu, A., Paul Suceveanu, A., Serafinceanu, C., & Pantea-Stoian, A. (2020). Metformin Indications, Dosage, Adverse Reactions, and Contraindications. In Metformin. https://doi.org/10.5772/intechopen.88675

Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Advances in Therapy, 36(2), 47–58. https://doi.org/10.1007/S12325-019-01080-8/TABLES/1