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CASE PRESENTATION hyperthyroidism

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CASE PRESENTATION hyperthyroidism

  1. 1. HYPERTHYROI DISMPRESENTED BY, KIRSHA.K.S 1yr MPHARM, PHARMACY PRACTICE
  2. 2.  A 40 years old woman was admitted in the hospital with complaints of:  Increased appetite and increased frequency of defecation since 3 months.  Difficulty in swallowing since 1 month. SUBJECTIVE EVIDENCE
  3. 3.   C/O increased appetite associated with increased frequency of panning motion, with slight abdominal pain.  c/o of difficulty in swallowing both for solid as well as liquid food.  c/o pain in the suprapubic region. HISTORY OF PRESENT ILLNESS
  4. 4.   k/c/o hyperthyroidism and on medication : T.Neo-Mercazole BD.  Developed thyroid swelling 3 months backs and taking medication since 1 month. HISTORY OF PREVIOUS ILLNESS
  5. 5.   No relevant family history.  Personal history  Sleep normal  Mixed diet  No addiction FAMILY HISTORY
  6. 6.  General physical examination  Pallor  Icterus  Clubbing  Cyanosis  Lymphadenopathy  Oedema OBJECTIVE EVIDENCE NEGATIVE
  7. 7.  1 2 3 4 5 TEMPERATURE normal normal normal normal normal BLOOD PRESSURE 110/70 mmHg 120/70m mHg 110/70 mmHg 130/80 mmHg 130/90 mmHg PULSE RATE 80 bpm 79 bpm 82 bpm 74 bpm 81 bpm SPO2 98% 98% 98% 99% 99%
  8. 8.   Patient conscious, co-operative oriented.  Butterfly shaped swelling present in the midline of neck and moves on deglutition.  CVS : S1S2 heard , no murmur.  RS : NVBS normal B/L SYSTEMIC EXAMINATION
  9. 9.  T3 – 3.47 pmol/L T4 – 17.04 pmol/L  TSH – 0.16 U/ml  RBS – 115 mg/dl  UREA -24 mg/dl  S.CREATININE – 0.5mg/dL LABORATORY INVESTIGATIONS
  10. 10.  HYPERTHYROIDISM ASSESSMENT
  11. 11.  sl no. BRAND NAME GENERIC NAME DOSE/ ROUTE OF ADMINISTRATI ON 1 2 3 4 5 1 T.DICLO DICLOFENA C 50mg BD Y 2 T.CIPLOX CIPROFLOX ACIN HCL 500mg BD Y 3 T.RANTAC RANITIDINE 150mg BD Y Y Y Y Y 4 T.BEPLEX FORTE VITAMIN SUPPLEMEN TS BD Y Y Y Y Y 5 T.NEO- MERCAZO LE CARBIMAZO LE 10mg BD Y Y Y Y Y 6 T.INDERAL PROPANAL OL 10mg BD Y Y 7 T.LOMOTIL DIPHENOXY LATE + ATROPINE 5mg stat Y TREATMENT CHART
  12. 12.   T.BEPLEX FORTE BD  T.RANTAC 150mg BD  T.NEO-MERCAZOLE 10mg BD  T.INDERAL 10mg BD DISCHARGE MEDICATION
  13. 13.  The objectives of management are  Eliminate the excess thyroid hormone and minimize the symptoms and long term consequences of hyperthyroidism. PLAN
  14. 14.   Drink 6 to 8 glasses of liquids each day.  Follow your diet, medication, and exercise routines very closely.  Do not use more than the recommended dose of diphenoxylate, and avoid activities requiring mental alertness such as driving or operating hazardous machinery  Limit the use of salt intake.  Eat foods high in protein and calories to prevent weight loss. PATIENT COUNSELLING
  15. 15.   Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified foods (e.g., cereal, juice). But may eat or drink dairy products or calcium-fortified foods with a regular meal, but do not use them alone when taking ciprofloxacin.  You should take Inderal at the same time each day, preferably with or immediately following meals MEDICATION RELATED COUNSELLING
  16. 16.   Inderal can cause nausea, vomiting, anxiety, insomnia and light headiness. It also prolong gestation and labor during pregnancy.  Diclofenac can cause epigastric pain, nausea, vomiting, rashes.  Lomotil may cause drowsiness, headache, loss of appetite ,headache and tiredness.  Carbimazole can cause rashes, pruritus, neutropenia and agranulocytosis. ADVERSE DRUG REACTIONS
  17. 17.   Inderal (propranolol), Ranitidine  ciprofloxacin, diclofenac Using diclofenac together with ciprofloxacin may increase the effects of ciprofloxacin.  Inderal (propranolol), diclofenac If you use propranolol for the treatment of high blood pressure, talk to your doctor before using it together with diclofenac DRUG INTERACTIONS
  18. 18.   No drug therapy has given for diarrhoea in the first day. PHARMACIST INTERVENTION
  19. 19.  THANK YOU…

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