Clinical Scenario (from part 1)
Kate is a 30-year-old woman who just delivered her second child two weeks ago. Two weeks after her delivery, Kate comes to your office to be evaluated. She states she has been tired, weak, and has widespread joint and muscle pain. Despite the mild weather, she notes that she is cold all the time and that instead of losing her “baby weight” she has actually gained about 15 pounds.
Kate has delivered two healthy children. She has no other medical history. It is her intention to breastfeed for at least the first 12 months. She continues to take her prenatal vitamins and plans on having an intrauterine device placed for contraception at her six-week follow-up. She is a non-smoker, does not have a history of illicit drug use, and is currently abstaining from alcohol though she has consumed alcohol socially prior to her pregnancies.
Her vital signs are as follows: Height 5’4”, weight 165 lb, Heart rate slowed at 48 beats per minute, blood pressure normal at 110/56, temperature normal at 98.2℉.
Treatment (from part 2)
You ask Kate some more questions, and she admits she has had problems with headaches and constipation. She also says that she feels “sluggish” and “in a fog”. You notice that she speaks slowly, and her voice seems rough. On examination, her skin is very dry, she has general puffiness, and examination of her thyroid reveals normal size.
Her lab work is as follows:
Kate’s lab values: Reference range:
TSH: TSH 25 μU/mL 0.5-4.70 µIU/mL
T4, total: 3 μg/dL 4.5-12.5 µg/dL
FT4: 0.4 ng/dL 0.8-1.8 ng/dL
T3: 80 ng/dL 80 -200 ng/dL
Thyroperoxidase antibodies (-) negative
Rationale (part 3)
It’s time to treat Kate and explain her treatment to her. In a half-page response, explain to Kate what type of treatment she will undergo and why. Be sure to also explain what the treatment will do for Kate’s physiology, and what you expect to happen to her lab values.
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