Thyroid Dysfunction Follow-Up

A 50-year-old female with a history of hypothyroidism treated with levothyroxine presents for a routine follow-up. She reports feeling well, but her weight has increased by 10 pounds over the past few months despite no changes in diet or activity level. She is concerned about her weight gain and asks about her thyroid medication.

Physical Exam Findings:

• General: Overweight female
• Vital signs: BP 130/80 mmHg, HR 72 bpm
• Neck: Normal thyroid size
• Skin: No dryness noted

Initial Investigations:

• TSH: 5.2 mIU/L (high)
• Free T4: 0.6 ng/dL (low)

MCQs:

1. What is the most appropriate action regarding the patient’s levothyroxine dose?
   • A) Decrease the dose
   • B) Increase the dose
   • C) Maintain the current dose
   • D) Discontinue the medication
2. Which dietary advice could help with weight management?
   • A) Eliminate all carbohydrates
   • B) Follow a balanced diet with controlled portion sizes
   • C) Increase fat intake
   • D) Avoid all dairy products
3. What should be discussed with the patient regarding monitoring?
   • A) TSH levels should be checked annually only
   • B) Regular monitoring every 3-6 months is essential
   • C) Only check TSH levels if symptoms worsen
   • D) No need to monitor if feeling well

Answers with Explanations:

1. Answer: B) Increase the dose
   Explanation: The elevated TSH indicates that the patient is not adequately treated, so an increase in levothyroxine dosage is warranted.
2. Answer: B) Follow a balanced diet with controlled portion sizes
   Explanation: A balanced diet with controlled portions can help manage weight effectively without compromising nutrition.
3. Answer: B) Regular monitoring every 3-6 months is essential
   Explanation: Patients on levothyroxine should have TSH monitored every 3-6 months to ensure appropriate dosing and to prevent complications.

Overview of the Topic: Long-term Management of Thyroid Disorders
Long-term management of thyroid disorders requires regular monitoring and dose adjustments based on thyroid function tests. Patient education regarding medication adherence and lifestyle modifications plays a crucial role in preventing complications.

Key Learning Points:

• Regular monitoring of thyroid function is critical for effective management.
• Patient education on weight management and the importance of medication adherence is essential for long-term health.