Q1. Which classes of diabetes medications are either weight-neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class. Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with, the frequency, and the route. Q3. What are the contraindications of your selected diabetic therapy? The patient returns to your office six months later, complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism. Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? Q5. What is the treatment of choice for hypothyroidism? What is

What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? 

The confirmation for hypothyroidism will be using Thyroid Stimulating Hormone (TSH) and Free thyroxine test (Free T4 test). TSH test is a blood workup that tests the levels of TSH in the blood. The Free T4 test is a blood workup to test the levels of unbound T4 hormone in the blood. Besides testing for hypothyroidism, these tests can also be used to test for hyperthyroidism. In a patient with hypothyroidism, the results for the TSH test will show elevated levels of TSH, while the test for Free T4 will show low levels of T4 below 0.4 mU/L, indicating reduced thyroid function. For a patient with hyperthyroidism, the results from the TSH test will show low levels of TSH, while the free T4 test will show elevated levels of T4 due to increased thyroid function, increasing production of thyroxine (T4) and triiodothyronine (T3).

Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

The treatment of choice for hypothyroidism is Levothyroxine (Chiovato et al., 2019). It is mainly marketed under Synthroid, Levoxyl, and Levo T. Levothyroxine works as a synthetic T4 hormone, therefore replacing the low levels of endogenously produced T4 due to reduced thyroid gland function. Once administered, Levothyroxine is activated into triiodothyronine (T3), which is critical in regulating metabolism and production of hormones for growth and development. The initial dose will include levothyroxine 25mcg, which is to be taken orally once daily in the morning.

Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

Thyroid replacement therapy can cause adverse effects, including hyperthyroidism and associated symptoms such as increased heartbeat, heart problems, anxiety, and loss of weight (Kalra et al., 2019). It can also cause osteoporosis. The patient will be educated on the therapy’s risks, medication safety, how to self-administer the therapy, the need for consistent administration of medication, any unexpected symptoms during the therapy, and foods and medications to avoid during the therapy.

 References

Adriana Stoica, R., Simona Ștefan, D., Rizzo, M., Iulia Suceveanu, A., Paul Suceveanu, A., Serafinceanu, C., & Pantea-Stoian, A. (2020). Metformin Indications, Dosage, Adverse Reactions, and Contraindications. In Metformin. https://doi.org/10.5772/intechopen.88675

Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Advances in Therapy, 36(2), 47–58. https://doi.org/10.1007/S12325-019-01080-8/TABLES/1

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Q1. Which classes of diabetes medications are either weight-neutral or cause weight loss? Please give one (1) example of a drug’s generic and trade name in that class. Q2. Based on the current guidelines of the ADA, it would be appropriate to treat her with monotherapy since the patient is hesitant to take any injections. What agent would you recommend? Please provide the trade name, generic name, the dose you would start the patient with, the frequency, and the route. Q3. What are the contraindications of your selected diabetic therapy? The patient returns to your office six months later, complaining of fatigue for the past two months, constipation, and heavy, irregular menses. Upon examination, you note that her skin is dry, and her fingernails are brittle. You suspect she has hypothyroidism. Q4. What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? Q5. What is the treatment of choice for hypothyroidism? What is

What lab workup should you obtain? What sort of results will you see in patients who have hypothyroidism and hyperthyroidism? 

The confirmation for hypothyroidism will be using Thyroid Stimulating Hormone (TSH) and Free thyroxine test (Free T4 test). TSH test is a blood workup that tests the levels of TSH in the blood. The Free T4 test is a blood workup to test the levels of unbound T4 hormone in the blood. Besides testing for hypothyroidism, these tests can also be used to test for hyperthyroidism. In a patient with hypothyroidism, the results for the TSH test will show elevated levels of TSH, while the test for Free T4 will show low levels of T4 below 0.4 mU/L, indicating reduced thyroid function. For a patient with hyperthyroidism, the results from the TSH test will show low levels of TSH, while the free T4 test will show elevated levels of T4 due to increased thyroid function, increasing production of thyroxine (T4) and triiodothyronine (T3).

Q5. What is the treatment of choice for hypothyroidism? What is the mechanism of action? Please provide the initial dose, trade, and generic name of the drug, route, and frequency.

The treatment of choice for hypothyroidism is Levothyroxine (Chiovato et al., 2019). It is mainly marketed under Synthroid, Levoxyl, and Levo T. Levothyroxine works as a synthetic T4 hormone, therefore replacing the low levels of endogenously produced T4 due to reduced thyroid gland function. Once administered, Levothyroxine is activated into triiodothyronine (T3), which is critical in regulating metabolism and production of hormones for growth and development. The initial dose will include levothyroxine 25mcg, which is to be taken orally once daily in the morning.

Q6. What are the adverse effects, and what important teaching will you provide this patient on thyroid replacement therapy?

Thyroid replacement therapy can cause adverse effects, including hyperthyroidism and associated symptoms such as increased heartbeat, heart problems, anxiety, and loss of weight (Kalra et al., 2019). It can also cause osteoporosis. The patient will be educated on the therapy’s risks, medication safety, how to self-administer the therapy, the need for consistent administration of medication, any unexpected symptoms during the therapy, and foods and medications to avoid during the therapy.

 References

Adriana Stoica, R., Simona Ștefan, D., Rizzo, M., Iulia Suceveanu, A., Paul Suceveanu, A., Serafinceanu, C., & Pantea-Stoian, A. (2020). Metformin Indications, Dosage, Adverse Reactions, and Contraindications. In Metformin. https://doi.org/10.5772/intechopen.88675

Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in Context: Where We’ve Been and Where We’re Going. Advances in Therapy, 36(2), 47–58. https://doi.org/10.1007/S12325-019-01080-8/TABLES/1

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