M.E. is a 29-year-old woman with a 7-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, and total cholesterol is 276 mg/mL.
Diagnosis: Primary hypothyroidism
Answer the following questions. Include two references, cited in APA style.
- List specific goals of treatment for M.E.
- What drug therapy would you prescribe? Why?
- What are the parameters for monitoring the success of the therapy?
- Discuss specific patient education based on the prescribed therapy.
- List one or two adverse reactions for the selected agent that would cause you to change therapy.
- What would be the choice for second-line therapy?
- What over-the-counter and/or alternative medications would be appropriate for M.E.?
- What lifestyle changes would you recommend to M.E.?
- Describe one or two drug–drug or drug–food interactions for the selected agent.