Primary Hyperthyroidism

Specific goals of primary hyperthyroidism therapy

The patient, M. S, suffers from excessive secretion of thyroid hormone. In most cases, the condition is caused by a tumor in the parathyroid tissues of the gland, which results in elevated levels of calcium in the blood (Oppenheimer, Braverman & Toft, 2005). The disease is manifested by problems in the digestive system, the appearance of kidney stones, and bone disease.

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Therefore, the primary goal of providing any therapeutic intervention to MS is to ensure that the euthyroid state is restored. In this way, the aim is to replace the normal level of thyroid hormone that has been affected by the disease, causing observable and measurable symptoms (Oppenheimer, Braverman & Toft, 2005).

Drug therapy

Propylthiouracil (PTU), an oral medication, will be the primary therapeutic intervention given to MS to manage the overactive thyroid gland. PTU is an anti-thyroid substance with a similar action mechanism to that of methimazole (Oppenheimer, Braverman & Toft, 2005). It inhibits both peroxidase and iodine from interacting with thyroglobulin, which in turn reduces the formation of Throxine (T4) and triiodothyronine (T3).

PTU is prescribed in tablet form, with each tablet measuring 50 mg. The patient should take 300mg/day. She will be asked to take 100mg doses 6 hours after the previous and 6 hours before the next dosage (Oppenheimer, Braverman & Toft, 2005).

Parameters for measuring the success of the drug therapy

Blood tests should be carried out regularly to monitor the results of the PTU treatment. In this case, the aim is to determine the amount of thyroid hormone in the human serum to ensure that it has reduced significantly. In addition, testing the level of thyroid hormone will be done to ensure that the drug does not cause excessive reduction of the hormone, which may lead to hypothyroidism (Boonen, Vanderschueren, Pelemans & Bouillon, 2009). The levels of TSH, T3, Free T3, Free T4, and T4 should be monitored to ensure that they are sustained at 0.45—4.50ilU/mL (for the TSH), 0.82-1.77ng/dl (for the free and direct T4), and 71-180 ng/dl (for T3) (Oppenheimer, Braverman & Toft, 2005). Failure to sustain these levels implies that the dosage of the PTU should be reconsidered or another drug applied (Oppenheimer, Braverman & Toft, 2005).

Specific patient education for hypothyroidism therapy

MS will be educated on the use of the drug, including prescriptions, side effects, and contraindications. In this case, she will be told to take the drugs once after every 8 hours. Secondly, MS will be informed that the drug is contraindicated for pregnancy, which means that she should state her pregnancy status (Oppenheimer, Braverman & Toft, 2005). Thirdly, she should be warned against increasing or decreasing her dose because it is likely to cause side effects or even fail to achieve the expected outcomes. Any case of worsening of the condition should be reported immediately to the relevant nurse or clinician. MS should also be informed that side effects expected include headache, stomach upset, nausea and vomiting, and mild rash or itching.

Adverse reactions of PTU that may cause a change of the drug or dose

PTU’s side effects are mild and do not cause serious problems. However, some effects may cause the termination of the drug. For example, the occurrence of muscle or joint pains, significant changes in the amounts of urine, and changes in blood cell amounts will lead to the termination of the drug.

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Choice of the second-line therapy

In case of a change in the drug, I will consider using carbimazole or methimazole instead because they have similar action mechanisms to that of PTU. However, it is also important to use drugs with other mechanisms such as the Beta-blockers like metoprolol (propranolol) to alleviate the side effects caused by antithyroid PTU (Ruda, Hollenbeak & Stack, 2008).

Complementary and alternative medicine

Radioiodine is an effective alternative medicine that complements antithyroid drugs. It will be orally in a liquid form. It will be rapidly absorbed by the thyroid gland, which leads to the destruction of some tissues. It is relatively cheap and can be offered over the counter due to its few side effects. However, it is contraindicated in pregnant patients as well as those with Grave’s disease or smokers.

Dietary and lifestyle changes recommended for M. E

Several lifestyle and dietary changes will be used to monitor rather than treat the condition. First, it is important to tell MS to monitor the amount of calcium and vitamin D getting in her diet (Barreras & Donaldson, 2007). She should take about 1,000 milligrams of calcium and about 600 IUs of vitamin D per day (Barreras & Donaldson, 2007). She should also take many fluids, especially water, to produce clear urine and reduce the risk of developing kidney stones (Barreras & Donaldson, 2007). She should exercise regularly, which should include strength training to maintain the strength of the bones. She should also avoid drugs that increase the level of calcium in the blood such as diuretics and lithium (Barreras & Donaldson, 2007).

Drug interactions

PTU has several but relatively drug interactions. For instance, drugs such as digoxin and warfarin have a significant ability to interact with PTU. In addition, PTU interacts with theophylline, which causes the clearance of the disease in patients with hyperthyroid.

References

Barreras, R. F., & Donaldson, R. M. (2007). Role of Calcium in Gastric Hypersecretion, Parathyroid Adenoma and Peptic Ulcer. New England Journal of Medicine 276(20), 1122–1124.

Boonen, S., Vanderschueren, D., Pelemans, W., & Bouillon, R. (2009). Primary hyperthyroidism: diagnosis and management in the older individual. Eur J Endocrinol. 151(3), 297-304.

Oppenheimer, J. H., Braverman, L. E., & Toft, A. (2005). A therapeutic controversy. Thyroid hormone treatment: when and what? J Clin Endocrinol Metab. 80(4), 2873-9.

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Ruda, J. M., Hollenbeak, C. S., & Stack, B. C. (2008). A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngology- Head and Neck Surgery, 132(4), 359-372.

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