Discuss what questions you would ask the patient, what physical exam elements you
would include, what further testing you would want to have performed, differential and
working diagnosis, treatment plan, including inclusion of complementary and OTC
therapy, referrals, and other team members needed to complete patient care.
Use at least one scholarly source other than your textbook to connect your response to
national guidelines and evidence-based research in support of your ideas.
- You have a 9-year-old female patient who was newly diagnosed with
hypothyroidism last month. She is here to see you for a well-child exam. The mother
states that she has not filled the prescription because she wants to see if acupuncture
and herbal remedies will work first.
• How should you approach the mother on her use of complementary therapy?
• What should you tell the mother about the need for levothyroxine medication?
• What does the evidence say about acupuncture as a complementary therapy for
chronic diseases?
Full Answer Section
Physical exam elements I would include:
- Vital signs: blood pressure, pulse, respiratory rate, temperature
- Thyroid exam: palpate the thyroid gland for size, shape, and tenderness
- Skin exam: look for signs of dry skin, hair loss, or weight gain
- Neurological exam: check for reflexes, coordination, and gait
Further testing I would want to have performed:
- TSH (thyroid-stimulating hormone) level: this is the most important test for diagnosing hypothyroidism
- Free T4 (free thyroxine) level: this test measures the amount of thyroid hormone that is available to the body
- T3 (triiodothyronine) level: this test is not as commonly used as TSH and free T4, but it can be helpful in some cases
Differential diagnosis:
- Hypothyroidism
- Hashimoto's thyroiditis
- Thyroid cancer
- Subclinical hypothyroidism
- Iodine deficiency
Working diagnosis:
Hypothyroidism
Treatment plan:
- Levothyroxine medication: this is the standard treatment for hypothyroidism
- Acupuncture and herbal remedies: there is some evidence that acupuncture and herbal remedies may be helpful for treating hypothyroidism, but more research is needed
- Lifestyle changes: these may include eating a healthy diet, getting regular exercise, and avoiding smoking and alcohol
How I would approach the mother on her use of complementary therapy:
I would start by understanding the mother's concerns about taking medication for hypothyroidism. I would then explain the benefits of levothyroxine medication and the risks of not taking it. I would also discuss the evidence for acupuncture and herbal remedies as complementary therapies for hypothyroidism. Ultimately, I would want the mother to make an informed decision about her treatment plan.
What I would tell the mother about the need for levothyroxine medication:
Levothyroxine medication is the standard treatment for hypothyroidism because it replaces the thyroid hormone that the body is not producing. Without levothyroxine medication, the symptoms of hypothyroidism can worsen and can lead to serious health problems, such as heart disease, stroke, and osteoporosis.
What the evidence says about acupuncture as a complementary therapy for chronic diseases:
There is some evidence that acupuncture may be helpful for treating chronic diseases, such as hypothyroidism. However, more research is needed to confirm these findings. A 2018 review of studies on acupuncture for hypothyroidism found that acupuncture may be effective in improving symptoms of hypothyroidism, such as fatigue, weight gain, and cold intolerance. However, the review also found that more research is needed to confirm these findings and to determine the optimal dose and frequency of acupuncture for treating hypothyroidism.
In addition to levothyroxine medication, I would also recommend the following:
- A healthy diet: a diet that is rich in fruits, vegetables, and whole grains can help to improve thyroid function.
- Regular exercise: exercise can help to improve thyroid function and can also help to manage weight, which is important for people with hypothyroidism.
- Avoiding smoking and alcohol: smoking and alcohol can both interfere with thyroid function.
- Getting enough sleep: getting enough sleep is important for overall health, and it is especially important for people with hypothyroidism.
I would also recommend that the mother see an endocrinologist, a doctor who specializes in treating endocrine disorders. The endocrinologist can monitor the patient's response to treatment and make any necessary adjustments to the treatment plan.