Q5. Treatment for Hypothyroidism-Initial Dose, Trade, and Generic Name, Route, Frequency and Mechanism of Action

Primary Care Medication Management

Q1. Classes of Weight Neutral or Weight Loss Inducing Diabetes Medications

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) agonists are major classes of diabetes medications that are weight-neutral or cause patients to lose weight during treatment. An example of a GLP-1 agonist class medication is Dulaglutide, usually sold under the brand name Trulicity.

Q2. Recommended Monotherapy Agent, Trade Name, Generic Name, Dosage and Route

Based on the current guidelines of the ADA, I would recommend metformin as the first-line monotherapy agent for treatment. Biguanide metformin is usually sold under the brand names Fortamet, Glucophage and Glucophage XR. The dosage for the metformin monotherapy drug is sequential. The initial dosage is 500 mg taken orally twice a day or 850 mg once a day. The maximum dose taken orally per day is 2550 mg.

Q3. Metformin Contraindications

The potential contraindications for metformin monotherapy include renal dysfunction, elevated serum creatine levels, although the serum creatine levels vary across gender and race, and tissue hypoxia (Corcoran & Jacobs, 2021). Congestive heart failure is also contraindicated with metformin use in advanced-age patients.

Q4. Lab Workup

I would carry out blood tests, including total thyroid-stimulating hormone (TSH), T4, T3, and thyroid antibody tests and TSH levels tests to evaluate thyroid function. For hypothyroidism, the results would show high TSH levels and low levels of T4. For hyperthyroidism, the results will show low TSH levels and elevated T4 levels. High thyroid antibody levels may indicate active thyroid problems.

The treatment of choice for the patient is hormone therapy. The generic for synthetic hormone therapy is Levothyroxine. It is sold under the brand names Synthroid, Levothroid, and Levoxyl, among others. It should be taken orally once a day, an hour before meals, at a dose of 50mg. As a synthetic form of T4, Levothyroxine normalizes T4 levels TO regulate body functions (Bianco & Taylor, 2020).

Q6. Adverse Effects of Thyroid Replacement Therapy

Thyroid replacement therapy may have some common side effects. However, there are adverse effects that the patient may experience, including shortness of breath, hives, rash, stomach pain, nausea, and swelling of hands, feet, or ankles (Bianco & Taylor, 2020). The patient should never use Levothyroxine as a treatment for obesity in weight loss. The patient also should report to a qualified physician if she experiences adverse side effects or has any allergies that may be linked to the therapy.

References

Bianco, A. C., & Taylor, P. (2020). Levothyroxine treatment and cholesterol in hypothyroidism. Nature Reviews Endocrinology, 16(4), 193-194.

Corcoran, C., & Jacobs, T. F. (2021). Metformin. In StatPearls [Internet]. StatPearls Publishing.