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Diagnostic and treatment

a) The pacient is suffering a primary hypothyroidism which corresponds to 99% of all

causes. It is caused by an underproduction of thyroid hormones by the thyroid

Clinical diagnosis is based on present:

- cold intolerance
-hoarse voice
-dry skin

Should be evaluated clinical manifestations conditioned by widespread slowing of

the metabolic processes, such as:
- Increase of weight that does not reach to morbid obesity
- Delay in the relaxation of osteotendinous reflexes
- Slow language
- Bradycardia
- Pretibial edema

Some signs and symptoms such as intolerance to cold, slow language, bradycardia
do confusing the diagnosis therefore it is necessary to perform an analysis of
thyroid-stimulating hormone (TSH) or thyrotropin it assesses the functionality of
the thyroid gland and measures the amount in blood of thyroid-stimulating

The diagnosis of primary hypothyroidism is confirmed with: High TSH with low T4L

b) Prescription medication (dose):

Prescribed you levothyroxine as treatment of first choice for hypothyroidism due
to it is effectiveness and long-term safety, easy administration, good intestinal
absorption, long half-life and low cost. The goal of treatment is resolving
symptoms and normalizing the levels of TSH and thyroid hormone concentrations.
Starting with 50 mcg/day oral dose (1/2 Tablet) for which is based on your weight,
body mass, age, pregnancy, serum TSH concentration and presentation of a
cardiovascular comorbidity.
Is recommended manage levothyroxine 60 minutes before breakfast or 3 hours
after dinner, because the concomitant administration of levothyroxine with food
may alter it is absorption.

Is necessary that the patient come back in one month to increase the dose should
be increased slowly to avoid an overdosing.
c) Psychological therapy
Consultation with the psychologist to treat the possible depression that could be
presenting because is tired most of the time and by the dramatic increase in
weight that had in recent months.The consultation is made with the purpose to
help her assimilate everything what is happening and which can be cooperative
when it comes to medication to have favorable results of his suffering and medical.

d) Differential side effects

It is necessary explains the possible adverse effects of medication that might occur
among those who are: hives or skin rash.
It is only necessary to go to the care unit medical if they persist for more than 1

In case of amenorrhea and other menstrual irregularities, palpitations, diarrhea,

anorexia, tremors, fever, headache, alopecia, irritability, nervousness, intolerance
to heat, sweating, insomnia, nausea/vomiting and weight loss should be to a
medical unit to it is valuation since it could have a thyroid hormone overdose

e) Because the treatment is responsibility of the patient, need to do a description of

the treatment develop and how it worked
The patient after 6 months using levothyroxine showed normalization of TSH levels
since disappeared the hoarse voice, there was a decrease of 8 kg of weight, the
coloration of his skin and texture are normal, to confirm such assumption was
asked another analis (TSH) thyroid stimulating hormone is what are values of 0.15
and 5 Miu/l which indicates a normal, all this thanks to its good cooperation,
responsibility and perseverance in its treatment, as well as their psychological
therapy dosage
After 6 months of treatment the patient ___ acude a routine query to see the
evolution of the treatment.
Dr. Enrique: Good afternoon Mrs______ .Could tell me how you have felt these
past months
Mrs._____: Good afternoon, in recent months hoarse voice attacks have
decreased, the last episode I was 2 months ago which lasted only a day, now I have
not been constipated
Dr. Enrique: The cold intolerance has been presented, like cough?
Mrs._____: No
Dr. Enrique: How you have felt with the diet, is following it?
Sra.___: I have been very comfortable with the diet, is very easy to prepare foods, I
have felt with more energy and now I can walk long blocks without polypnea. I
have also practiced a little exercise.
Dr. Enrique: As we can see yours hoarse voice episodes have decreased, in these
six months has dropped 8 kg, which indicates a good prognosis since because you
are following to the letter the taking of medication and diet that was provided to
you by the nutriologist . So we are seeing favorable results from the medication.

It will send you to do a laboratory study to confirm that levels of thyroid-

stimulating hormone has declined. By now you will continue with your medication
for a month, will submit to query since the results of laboratory studies, you have
to be able to assess its high, you will continue with a dose of 40 mcg/day of
levothyroxine average tablet before breakfast and half tablet before eating, this
for when the drug release full not cause any adverse effects for removing him
abruptly, I congratulation your dedication and responsibility to follow my
instructions and diet because this has helped us to that you are improving.