Problem Identification
Drug therapy problem occurs in situations when the therapeutic needs of patients fail to be met. One of the treatment problems that could occur in the case of a patient with Grave’s disease is an adverse reaction to the drug (Brent, 2008). Issuing the patient with a small dose than is required could also occur. The patient may also require additional therapy based on the symptoms presented. The patient may also be issued with unnecessary drugs during therapy.
The severity of hyperthyroidism is evidenced by the presence of various factors. The patient reports that she has lost weight despite having a good appetite and adequate food intake (Francesca & MarcocciMichele, 2014). The patient states that she feels hot most of the time and has frequent sweating episodes, both of which are evidenced by the elevated body temperature. The patient complains of palpitations as well as fine tremors. The patient exhibits some level of emotional liability as evidenced by the reported irritability. The patient has an asymmetrically enlarged thyroid accompanied by neck vessels pulsations. The patient reports that she has lost her hair a fact that is evidenced by how sparse her hair is in the temporal area.
The laboratory results indicate that the patient has hyperthyroidism. Her total T4 level is elevated from the normal range of 4.5-11.2 mcg/dL to 24 mcg/dL. The patient also has an elevated level of free T4 as well as TSH levels. The T3 resin uptake for the patient is 35%, a figure that is higher than the normal range of 25%. The total T3 is also markedly elevated to 550 ng/dl from the normal range of 80-180 ng/dl. The patient’s free thyroxine level is also raised (Francesca & MarcocciMichele, 2014).
Desired Outcome
The desired outcome in this case, in this case, is that the symptoms are adequately controlled. The current practice seeks to ensure that the patient attains hypothyroidism. The state of hypothyroidism grants a higher guarantee the patient doesn’t develop hyperthyroidism. The therapy is a departure from what would be ordinarily expected such as adopting a treatment that restores a state of euthyroidism. The treatment modality that is adopted should be anchored on the goal of being cost-effective.
Therapeutic Alternatives
A Patient with hyperthyroidism can be managed with several non-pharmaceutical therapies. The patient should avoid any food or food supplements that contain high levels of iodine (Santos, Pascual & Galofre, 2012). The patient should reduce the level of activity until she acquires a state where her hyperthyroidism is adequately controlled. For patients who are photophobic as well as have other ophthalmic symptoms, they should wear sunglasses that are tight-fitting.
When treating Grave’s disease, there are a number of therapies that can be utilized. The patient can be treated using radioactive iodine which is administered orally. Cooper (2005) states that as the thyroid takes up iodine for hormone production, the radioactive iodine is also absorbed into thyroid cells from where it destroys the overactive cells. Another pharmaceutical approach that can be adopted involves administering anti-thyroid medication. The drug serves to alter the use of iodine in the production of hormones (Cooper, 2005). The use of beta-blockers is also one of the pharmacological measures that can be used to manage hyperthyroidism. The drugs act by inhibiting the effect of thyroid hormones and as such offer relief to the symptoms. Cortical steroids are also prescribed to relieve the ophthalmic symptoms.
Optimal Plan
The drug of choice in managing the patient is Methimazole (Tapazole). Methimazole is available in the form of pills allowing for oral administration. The appropriate dose for the patient is 10mg administered orally in eight-hour intervals. The patient should continue with the medication for a period of twelve to eighteen months until the TSH level return to normal.
Outcome Evaluation
During the treatment period, the patient should undergo laboratory tests to evaluate the effectiveness of the treatment. The patient’s levels of free T4, as well as free T3, should be monitored. TSH levels should be checked as a euthyroid state is indicated when TSH is undetectable (Francesca & MarcocciMichele, 2014). The glucose levels of the patient should also be regularly monitored.
Clinical symptoms should also be monitored during the therapy period. Fever and sore throat symptoms indicate the development of agranulocytosis and as such it warrants a complete white blood cell count. The patient should also be monitored for thrombocytopenia. Other clinical symptoms such as severe vomiting, dizziness as well as body swelling should also be observed.
Patient Education
Patient compliance can be increased by encouraging the patient to report any signs of sore throat, as well as fever. The patient should be advised to indicate other over the counter medications that they are taking so as to avert any possible drug interaction (Brent, 2008). The patient should also be informed about the need to tell the clinician if she plans to get pregnant. Drug discontinuation should occur forthwith in case there are any symptoms of hepatic injury such as jaundice and acholic stools. The patient should also be informed that she needs to alert the clinician upon discontinuing the drug.
References
Brent, G. (2008). Graves’ Disease. New England Journal of Medicine, 358(24): 2594- 2605.
Cooper, D. (2005). Antithyroid drugs. New England Journal of Medicine, 17, 352:905.
Francesca, M., & MarcocciMichele, M. (2014). Diagnosis and classification of Graves’ disease. Autoimmunity Reviews, 13, 398-402.
Santos, P., Pascual, E., & Galofre, J. (2012). Management of Subclinical Hyperthyroidism. International Journal of Endocrinology Metabolism, 10(2):490- 496.