Maria is a 29-year-old woman with a seven-month history of heavy, irregular menses, a 5-lb weight gain, constipation, and decreased energy. Her past history is unremarkable. She takes no prescription medications but uses iron and calcium supplements. She has a family history of thyroid disease. On examination, her weight is 152 lbs, her heart rate is 64 bpm, and her blood pressure is 138/86. Her thyroid gland is mildly enlarged, without nodularity. She has trace edema in her lower extremities, and her reflexes are slow.
Laboratory studies are as follows:
TSH is 15.3 mIU/mL (elevated), free T4 is 0.3 mIU/mL (decreased), and total cholesterol is 276 mg/mL.
Diagnosis: Primary Hypothyroidism
1. List specific goals of treatment for Maria.
2. What drug therapy would you prescribe? Why?
3. What are the parameters for monitoring the success of the therapy?
4. Discuss specific patient education based on the prescribed therapy.
5. List one or two adverse reactions for the selected agent that would cause you to change therapy.
6. What would be the choice for second-line therapy?
7. What over-the-counter and/or alternative medications would be appropriate for Maria?
8. What lifestyle changes would you recommend to Maria?
9. Describe one or two drugâ€“drug or drugâ€“food interactions for the selected agent.