Hypothyroidism (underactive thyroid) is a condition in which thyroid gland doesn't produce enough of hormones. Hashimoto's disease is an autoimmune disorder in which your immune system creates antibodies that damage your thyroid gland. Risk factors include age, sex, heridity, other autoimmune disease, radiation exposure. Signs and symptoms of hypothyroidism include Fatigue and sluggishness, Pale, dry skin, puffy face, hair loss, Unexplained weight gain, Depression, Memory lapses.

1. CASE PRESENTATION ON
AUTOIMMUNE
HYPOTHYRODISM
By:
B.Sunil Kumar Nayak,
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2. Introduction
Hypothyroidism (underactive thyroid) is a condition in which
thyroid gland doesn't produce enough of hormones. Hashimoto's disease is
an autoimmune disorder in which your immune system creates antibodies
that damage your thyroid gland.
Risk factors include age, sex, heridity, other autoimmune disease,
radiation exposure. Signs and symptoms of hypothyroidism include
Fatigue and sluggishness, Pale, dry skin, puffy face, hair loss,
Unexplained weight gain, Depression, Memory lapses.
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3. Complications
include goiter, Heart
problems, mental health
issues
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4. Demographic details
Age : 57 years
Sex : Female
Ward : FMW
No. of days Hospitalized : 5 days
Complaints:
Facial puffiness since 1 month, unable to take food, throat pain,
depressive mood and hypopigmentation of skin
Histories :
2 months back she went to hospital with a complaints of
shortness of breath and multiple episodes of vomitings.
Medical history- History of Autoimmune Hypothyrodism,
Hypertension and Asthma.
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5. • Medication history
For Hypothyroidism- Tab. Thyroxine sodium 50mcg-po-od
For Hypertension- Tab.Atenolol 50mg+ chlorthalidone-12.5mg-po-od
For Asthma- levosalbutamol rotacaps-100mcg –sos
• Personal history
Nothing significant
Provisional diagnosis
Autoimmune hyperthyrodism with dyselectrolytemia…?
Depressive disorder…?
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6. Pharmaceutical care plan
Subjective evidence:
Facial puffiness, unable to take food, throat pain, depressive
mood and hypopigmentation of skin
Demise of patients husband, suicide attempt
Objective evidence:
• T3-64 ng/ml (80-180ng/ml)
• T4- 2.78 µg/dl (4.6-12 µg/dl)
• TSH- 40µIU/ml(9-30µIU/ml)
• Anti-smith D1 antibodies - Positive
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7. Other investigations
HBsAG : Non-Reactive HCV : Non-Reactive
HIV 1&2 : Negative CUE : Normal
ACTH-plasma : 22.60 pg/ml(<46.00)
CBP
Hb: 12.6 g/dl N : 70
WBC : 4600 c/cumm L : 28
RBC : 5.0 M.Cells/cumm E : 01
Platelets : 1.2 L/cumm(1.5-4.0) M : 01
B : 00
RBS: 105mg/dl
Bl.Urea: 16 mg/dl Na+ : 128 m.mol/L(135-145)
Sr.creatinine: 0.7 mg/dl K+ : 3.3 m.mol/L(3.5-5.5)
USG Submandibular region Cl- : 93 m.mol/L(95-105)
lymphnodes enlarged
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8. Assessment :
Based on subjective and objective evidence the patient was diagnosed
as Autoimmune Hypothyrodism.
Final diagnosis:
Autoimmune Hypothyrodism
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9. Plan
Goals of the treatment
• Reduce the symptoms such as Facial puffiness, throat pain,
depressive mood and hypopigmentation of skin.
• To prevent from the complications like goiter, Heart problems,
mental health issues.
Monitoring parameters
• Monitor the levels of thyroid hormones.
• Monitor the mental status.
• Monitor the levels of electrolytes.
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10. Generalized treatment
• The treatment of choice for hypothyroidism is thyroid hormone
replacement. The drug of choice is orally administered
levothyroxine sodium.
• The standard dose is 1.6-1.8 mcg/kg lean body weight per day, but
the dose is patient dependent.
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11. current therapy
S.NO DRUGS DOSE ROA FREQ DA DS
1 NS 1pint IV OD 1 5
2 Inj.Pantoprazole 40mg IV OD 1 5
3 Inj.Ondansetron 4mg IV BD 1 5
4 Tab.Monteleukast+
Levocertizine
10+5 mg PO OD 1 5
5 Tab.Thyroxine sodium 50mcg PO OD 1 5
6 Inj.Tramadol 100mg Slow IV SOS 1 5
7 Syp.Diastase+Pepsin 2tbsp PO TID 1 5
8 Tab.Fluxetine 20mg PO OD 1 5
9 Tab.Paracetamol+Diclofenac+
Serratiopeptidase
325+50
+10 mg
PO BD 1 5
10 Tab.Atorvastatin 10mg PO OD 2 5
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12. Day wise assessment and notes
DAY PR (BPM) BP (mm Hg) OTHERS
1 70 90/60 -
2 74 90/70 c/o Hypopigmentation, Pain in Rt.Cheek
3 74 90/70 c/o Hypopigmentation
4 72 100/80 -
5 74 100/80 DISCHARGE
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13. Discharge medication
• Tab.Thyroxine sodium
50mcg-po-od
• Tab.Fluxetine
20mg-po-od
• Syp.Diastase+Pepsin
2 tbsp-po-bid (1/2 before food)
• Tab.Atorvastatin
10mg-po-od
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14. Psychiatry referral
• c/o refusal of food and loss of taste in food since 4 months
• Weeping spells + low dull mood since 4 months
• Loss of intrest and not cooking
• Isolated in one room since 4 months
• Suicidal attempt 4 months ago
• Not taking medication on time
 Imp:- Major Depressive Disorder
 Precipitating factor :- Demise of Husband
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15. Patient counselling
About disease
Patients representative was counselled regarding the disease
that ‘hypothyrodism is the condition where the thyroid gland doesn't
produce enough of hormones’. symptoms of hypothyroidism include
Fatigue and sluggishness, Pale, dry skin, puffy face, hair loss,
Unexplained weight gain, Depression, Memory lapses. And also
counselled that to give the motivational support to the patient.
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16. About medication
• Patient’s representative was counselled regarding the medications
that should take in time and don’t skip the medication.
• Syp.Aglozyme should be taken ½ before the food 2 tbsp twice daily.
• Tab.Thyroxine sodium should be taken once daily before the
breakfast.
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17. About life style modifications
• Exercise regularly but within limits. (No stressful exercise should be
done)
• Avoid eating the cruciferous vegetables like cabbage and
cauliflower, as they block thyroid hormone production.
• Manage stress with yoga or meditation.
• A good sleep is necessary because it helps to regulate the stress
hormone cortisol
• Patient is suggested to join in the rehabilitation centre as it may
decrease the depression.
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18. Thank you
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