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Chapter 41- Thyroid

Terms in this set (31)

Chief Complaint: "I have no energy".

History of Present Illness: KB is a 32 year-old female who comes into the outpatient clinic on March 10th complaining of low energy, recent weight gain of 15 pounds, foggy memory, and feeling cold even though it is sunny outside.

Past Medical History: Allergic rhinitis, GERD, hypothyroidism

Current Medications: Cetirizine 10 mg PRN, Mylanta 20 mL Q6H, Tylenol 325 mg Q4-6H PRN, Omega-3 fatty acid 1 gram daily, MVI daily

Vitals:
Height: 5'7" Weight: 138 lbs
BP: 129/80 mmHg HR: 85 BPM
RR: 20 BPM Temp: 98.6ºF Pain: 1/10

3/10 Labs:
Na (mEq/L) = 141 (135 - 145)
K (mEq/L) = 4.2 (3.5 - 5)
Cl (mEq/L) = 100 (95 - 103)
HCO3 (mEq/L) = 28 (24 - 30)
BUN (mg/dL) = 18 (7 - 20)
SCr (mg/dL) = 0.9 (0.6 - 1.3)
Glucose (mg/dL) = 110 (100 - 125)
Mg (mEq/L) = 1.9 (1.3 - 2.1)
PO4 (mg/dL) = 4.4 (2.3 - 4.7)
Ca (mg/dL) = 9.5 (8.5 - 10.5)
TSH (mIU/L) = 32 (0.3-3.0)
Free T4 (mg/dL) = 0.3 (0.9-2.3)
hCG-

Plan:
Hypothyroidism. Start levothyroxine 75 mcg daily. Follow-up visit on 4/14.

4/14 Labs:
Na (mEq/L) = 143 (135 - 145)
K (mEq/L) = 4.1 (3.5 - 5)
Cl (mEq/L) = 102 (95 - 103)
HCO3 (mEq/L) = 26 (24 - 30)
BUN (mg/dL) = 15 (7 - 20)
SCr (mg/dL) = 0.8 (0.6 - 1.3)
Glucose (mg/dL) = 15 (100 - 125)
Mg (mEq/L) = 1.8 (1.3 - 2.1)
PO4 (mg/dL) = 4.1 (2.3 - 4.7)
Ca (mg/dL) = 9.7 (8.5 - 10.5)
TSH (mIU/L) = 4.7 (0.3-3.0)
hCG+

Question

Was KB's initial levothyroxine dose a full replacement dose based on her ideal body weight?
Answer

A
Yes, it was a full replacement dose.
B
No, the dose should have been 50 mcg daily
C
No, the dose should have been 100 mcg daily
D
No, the dose should have been 112 mcg daily
E
No, the dose should have been 125 mcg daily
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