Mary is a 35-year-old woman that has been diagnosed with hypothyroidism. Her labs today show a TSH of 20, MCV 78, MCHD 26, Ferritin 9, TIBC 418. She has a history of iron deficiency anemia for 2 months. Current medications include Kelp tablets daily, ibuprofen 400 mg daily as needed, and ethinyl estradiol/norgestrel one tablet daily.What medication would you start this patient on for her hypothyroidism? How would you monitor this patients response to the medication? What education would you provide regarding her medications and their interactions?

To Prepare:
Review the case studies above and answer ALL questions.
When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patients current medications.
Use clinical practice guidelines in developing your answers. Please review all Required Learning Resources. Use the Medscape app or website to complete assignment.
Include at least three references to support each scenario and cite them in APA format. Please include in-text citations. You do not need an introduction or conclusion paragraph.



Sample Answer

Sample Answer


Medication Management for Hypothyroidism in a Patient with Iron Deficiency Anemia

Thesis Statement: In managing hypothyroidism in a patient with iron deficiency anemia, it is crucial to consider potential drug interactions and monitor the patient’s response to treatment effectively.

Medication Recommendation:

For Mary’s hypothyroidism, the preferred medication would be Levothyroxine, which is the standard treatment for hypothyroidism. Levothyroxine should be initiated at a low dose to avoid exacerbating her symptoms.


– Drug: Levothyroxine
– Dose: 25 mcg
– Route: Oral
– Frequency: Once daily in the morning on an empty stomach
– Special Instructions: Take at least 30 minutes before any food or other medications
– Dispensed: 30 tablets (30 days supply)

– Refills: 1

Monitoring Response to Medication:

To monitor Mary’s response to Levothyroxine, we would follow up with her in 6-8 weeks to assess her symptoms and repeat her TSH levels. If her symptoms persist or her TSH levels remain elevated, the dose of Levothyroxine may need adjustment.

Education Regarding Medications and Interactions:

1. Levothyroxine: Emphasize the importance of taking Levothyroxine on an empty stomach and separately from other medications to ensure optimal absorption.

2. Kelp Tablets: Due to the iodine content in Kelp tablets, inform Mary that these may interfere with thyroid function tests and should be avoided while on Levothyroxine.

3. Ibuprofen: Advise Mary to limit the use of ibuprofen as it can affect thyroid hormone levels and potentially decrease the effectiveness of Levothyroxine.

4. Ethinyl Estradiol/Norgestrel: Discuss with Mary the potential interactions between Levothyroxine and oral contraceptives, as estrogen-containing medications may impact thyroid hormone levels.


1. American Thyroid Association. (2021). Hypothyroidism (Underactive).

2. National Institute for Health and Care Excellence. (2019). Hypothyroidism.

3. Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., … & Woeber, K. A. (2012). Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocrine Practice, 18(6), 988-1028.


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