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PATIENT CARE PROCESS

Patient Care Process for the Management of Hyperthyroidism

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Collect

  • Patient characteristics (e.g., age, race, sex, pregnancy status)

  • Patient history (past medical, family, social) including patient signs and symptoms: warm, smooth, moist skin, palpitations, exophthalmos, pretibial myxedema and unusually fine hair; anxiety, tremor, heat intolerance, tachycardia, weight loss, and menstrual disturbances. See Clinical Presentation Box.

  • Current medications (including OTC and herbal medication use)

  • Objective data

    • Heart rate, blood pressur (BP), weight, and body mass index (BMI)

    • Labs (e.g., FT4, TT3, TSH, thyroid-stimulating antibodies; serum electrolytes, Scr, ALT)

    • Other diagnostic tests when indicated (e.g. thyroid ultrasound, RAI uptake scan)

Assess

  • Cause of hyperthyroidism (see Table 75-3)

  • Current medications that may contribute to or worsen hyperthyroidism

  • Current medications that may interact with anti-thyroid therapy

  • Appropriateness and effectiveness of current anti-thyroid regimen

Plan*

  • Drug therapy regimen including specific anti-thyroid therapy, dose, and duration (see Table 75-5)

  • Monitoring parameters including efficacy (e.g. resolution of signs and symptoms) and safety (symptomatic hypothyroidism, adverse effects of medications), laboratory tests (TSH, FT4, TT3, and CBC), and timeframe

  • Patient education (e.g. purpose of treatment, dietary and lifestyle modification, drug therapy)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up

Follow-up: Monitor and Evaluate

  • Resolution of signs and symptoms

  • Presence of adverse effects

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals

 

Patient Care Process for the Management of Hypothyroidism

Image not available.

Collect

  • Patient characteristics (e.g., age, race, sex, pregnancy status)

  • Patient history (past medical, family, social) including signs and symptoms: coarse skin and hair, cold or dry skin, periorbital puffiness, and bradycardia; cold intolerance, weight gain, constipation, weakness, muscle cramps, myalgia, and galactorrhea). See Clinical Presentation Box.

  • Current medications (including OTC and herbal medication use)

  • Objective data

    • Heart rate, blood pressure (BP), weight, and body mass index (BMI)

    • Labs (e.g., TSH, FT4, TT3, anti-TG antibodies, TPO antibodies; serum electrolytes, Scr, ALT)

    • Other diagnostic tests when indicated (e.g. thyroid ultrasound, RAI uptake scan)

Assess

  • Cause of hypothyroidism (see Table 75-8)

  • Current medications that may contribute to or worsen hypothyroidism

  • Current medications that may interact with thyroid hormone replacement therapy

  • Appropriateness and effectiveness of current thyoid hormone replacement regimen

Plan*

  • Drug therapy regimen including specific thyroid hormone replacement therapy and dose (see Table 75-9)

  • Monitoring parameters including efficacy (e.g. resolution of signs and symptoms) and safety (arrhythmias, angina, osteoporosis or symptomatic hyperthyroidism), laboratory data (TSH, FT4, TTS) and follow-up monitoring timeframe

  • Patient education (e.g. purpose of treatment, dietary and lifestyle modification, drug therapy)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up visits and laboratory tests

Follow-up: Monitor and Evaluate

  • Resolution of signs and symptoms

  • Presence of adverse effects

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, ...

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