Thursday, June 1, 2023

After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism.. Primary hypothyroidism



After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism.

Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

  • a- Primary hypothyroidism.
  • b- Graves’ disease.
  • c- Thyrotoxicosis.
  • d- Euthyroidism.

Answer A.

Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism.
It is contraindicated in Graves’ disease and thyrotoxicosis because these conditions are forms of hyperthyroidism.
Euthyroidism, a term used to describe normal thyroid function, wouldn’t require any thyroid preparation.

The thyroid is a small gland at the base of the neck. Its proper functioning is crucial for good health. A deficiency of thyroid hormone production (or hypothyroidism) causes strong disorders that require treatment for life to be controlled.

Hypothyroidism is a pathological situation in which there is a decrease in secretions of thyroid hormones, most often because of a dysfunction of the thyroid gland. The disease has become quite rare in industrialized countries since table salt is iodized, but it is still more common in developing countries.

Causes of hypothyroidism:

Hypothyroidism is called primary when it is due to a failure of the thyroid. This appears consecutively to iodine deficiency, thyroiditis. It can also be genetic or caused by certain treatments or medications. Hypothyroidism is then characterized by too low secretion of T3 and T4 hormones, involved in particular in the regulation of the basic metabolism of the cells of the body.

In the past, the main cause of hypothyroidism was iodine deficiency, an essential element in the production of these two hormones. In some areas, it led to mental developmental delays when it appeared early in life: it was called cretinism. The systematic introduction of iodized salt into the diet has greatly reduced the incidence of the disease in developed countries.

More rare but nevertheless existing, hypothyroidism can also be secondary. In this case, it is due to dysfunction of the pituitary gland, a gland of the brain, whose secretion of thyroid stimulating hormone (TSH) is insufficient. This hormone has the function of stimulating the hormones T3 and T4 of the thyroid.

Symptoms of hypothyroidism:

The patient with hypothyroidism develops a range of variable symptoms. A feeling of chronic fatigue and disturbance of attention and memory can occur. Despite a proper diet and an appetite that is not excessive, weight gain is frequently observed. At the muscle level, cramps and pains are more common. In addition to other consequences, the patient with hypothyroidism may also suffer from depression.
In the most serious cases, there may be a loss of consciousness, the patient then entering a coma called myxedema.

Treatment of hypothyroidism:

To cure hypothyroidism, replace the failing hormones. Thus, levothyroxine, which stabilizes and normalizes secretions of T3 and T4, is most often used. The disease being chronic, this treatment must be continued throughout life.