Chapter 31: Thyroid and Antithyroid Drugs Case Study R.

C a 28-year-old woman has been diagnosed with hyperthyroidism due to Graves disease. Her health care provider has explained the proposed therapy with propylthiouracil to her and her husband. She has no other known health problems at this time. 1. What laboratory studies will be performed before drug therapy with propylthiouracil is started? Explain. First, a pregnancy test should be done because propylthiouracil is Pregnancy Category D and thus should not be taken by pregnant women. Baseline renal and liver function studies should be done because of possible adverse effects on the function of these organs. In addition, baseline white blood cell, red blood cell, and platelet counts should be done because this drug may cause agranulocytosis and pancytopenia. 2. R.C. asks, What do I need to know while Im taking this drug? List pertinent patient teaching points. Patient teaching points for the patient taking propylthiouracil include the following: o Avoid foods high in iodine, such as seafood, iodized salt, soy products, tofu, and turnips. The iodine may interfere with the action of the medication. o Take the medication with food to avoid GI upset, and be sure to take it at the same time every day to maintain consistent drug levels in the body. o Symptoms may not start to improve until after two weeks of therapy. o Any fever, sore throat, mouth ulcers/sores, and eruptions of the skin should be reported to the health care provider immediately as well as any unusual bleeding or bruising. In addition, signs of hypothyroidism, such as weight gain, cold intolerance, and depression, should be reported. o The drug should not be stopped abruptly. 3. After a month of therapy, R.C. comes into the health care providers office for a follow up visit. Shes upset because a friend told her about a relative who had antithyroid therapy for cancer and said he was radioactive. How should she be answered? Therapy with propylthiouracil is NOT the same as therapy with radioactive iodine (131I). Radioactive iodine works by destroying the thyroid gland, in a process known as ablation. It does this by emitting destructive beta rays once it is taken up into the follicles of the thyroid gland. Propylthiouracil works to inhibits the formation of thyroid hormone (but does not inactivate already existing thyroid hormone) in the body. The effect is a decrease in the thyroid hormone level and normalizing the overall metabolic rate. 4. Six months later, R.C. calls the office and says, I think I might be pregnant. What do I do about taking this drug? What should the nurse tell her? R.C. will need to be seen by the health care provider immediately. Propylthiouracil is a Pregnancy category D medication, which means that a pregnant woman should not take it. She will need to be monitored closely if the drug is stopped abruptly because of the effect this may have on her thyroid hormone levels.