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Abstract: A 56-year-old aunt Zhou, who had a total thyroid excision on one side and a quarter excision on the other side for thyroid cancer ten years ago, had pathology suggestive of medullary thyroid cancer and had been taking levothyroxine sodium tablets after surgery. The patient came to the clinic to ask if she could stop taking the medication. Given that the patient has no symptoms such as panic, sweating, fear of heat, wasting and weakness, and that her condition is stable, after communication, the patient was informed that she needed lifelong replacement therapy and could not stop the medication.
Basic information】Female, 56 years old
Disease Type】Hypothyroidism
Hospital】Xuanwu Hospital of Capital Medical University
Date of consultation】April 2022
Treatment plan】Medication (levothyroxine sodium tablets)
Treatment period】Lifelong replacement therapy
Effectiveness of treatment] Symptom relief and significant treatment effect
I. Initial interview
Patient Auntie Zhou, 56 years old, was diagnosed with thyroid cancer in a local hospital 10 years ago due to a thyroid mass, and underwent thyroid surgery to remove one side and a quarter of the other side. After the surgery, the patient has been taking levothyroxine sodium tablets in gradual increments for nearly 10 years. The patient has no obvious self-conscious symptoms, nor does he have panic attacks, sweating, fear of heat, or loss of weight. There was also no significant drowsiness, fatigue, joint pain, or weight gain. Blood lipids were in the normal range. The patient came to the hospital and wanted to ask if he could stop using levothyroxine sodium tablets because he had been using them for almost 10 years and the patient felt that the thyroid hormone had been supplemented enough.
II. Treatment history
The patient’s thyroid hormone levels were tested and the results showed that they were within the normal range. The patient’s symptoms were considered to be hypothyroidism. We explained to the patient that since thyroid tissue was surgically removed, thyroid hormones are mainly synthesized and secreted by thyroid tissue, so after the removal of thyroid tissue, a deficiency of thyroid hormones will occur, resulting in secondary hypothyroidism. It is important to give lifelong thyroid hormone replacement therapy, so it is not possible to stop the medication.
III. Treatment effect
At present, the patient has no obvious clinical signs and symptoms, no fear of cold, little sweating, joint pain, weight gain, mucus edema, and also the patient does not have some conditions of hypermetabolic syndrome, such as panic, sweating, fear of heat, anxiety, insomnia, excessive sweating, and weight loss. The level of thyroid hormone in the laboratory examination was within the normal range, suggesting that although the thyroid gland was surgically removed at present, the supplemented levothyroxine sodium tablets could meet the metabolic needs of the body, and the patient did not experience either under-supplementation or over-supplementation of thyroid hormone. This suggests that the current treatment is effective and that the medication used is appropriate and lifelong treatment is required.
IV. Precautions
Common causes of hypothyroidism include surgical treatment, as well as certain medications that result in treatment. Patients should take thyroid hormones for life and have their thyroid hormone levels checked regularly. It is important to take regular medication and to eat a moderate amount of iodine in the diet, neither too much nor too little. Patients should exercise properly and check the level of thyroid hormone and lipid metabolism in time, because the abnormalities of lipid metabolism can indirectly reflect whether the concentration of thyroid hormone in the body is appropriate. At the same time, patients should quit smoking and drinking, do not stay up late and stay away from radiation.
V. Personal insight
Hypothyroidism is a common and frequent endocrine disease. Most of the common causes of hypothyroidism are due to thyroid surgery, such as hyperthyroidism, thyroid nodules, thyroid cancer, all of which may be operated, and other causes may be due to nuclear therapy. There are also some patients who use certain specific drugs, such as chemotherapy drugs, which may lead to a decrease in thyroid tissue or a decrease in the ability of thyroid tissue to synthesize thyroid hormone, and in this case, patients who supplement with external thyroid hormone must be careful to ask the patient which cause is responsible for hypothyroidism, like the patient in this case, after surgery to remove thyroid tissue are required to use left The patient’s thyroid hormone replacement therapy is required for life.