Reference no: EM133866889

Case Scenario - Hypothyroidism

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 (6.8 kg) 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 says she has general body aches and pains with frequent muscle cramps and constipation. You note she is dressed inappropriately warmly for the weather.

LAB TEST RESULTS:

TSH= 20.9 mU/L

TRH= 18.8 ng/dL

T3= 24 mU/L

FREE T4= 0.2 ng/dL

1. List at least 8 general questions you might ask R.M. to help determine what is going on.
2. What are some potential causes for R.M.'s symptoms? Identify at least 4 potential causes.
3. Interpret R.M.'s laboratory results.
4. The practitioner affirms a diagnosis of hypothyroidism. With this diagnosis, identify at least 5 other signs and symptoms would you want to assess.
5. The practitioner prescribes levothyroxine 1.7 mcg/kg body weight per day. Identify at least 6 teaching points that you would provide R.M. about levothyroxine.
6. What other general teaching issues will you address with R.M. about hypothyroidism? Identify at least 6 general teaching.
7. Outline at least 6 simple expected outcomes for R.M.
8. A few weeks later, R.M. calls the clinic saying she cannot remember whether she took her thyroid medication. What other data should you obtain, and what would you tell her?
9. Discuss 2 ways you can help R.M. remember to take her medication.