Discuss what questions you would ask the patient, what physical exam elements you
would include, what further testing you would want to have performed, differential and
working diagnosis, treatment plan, including inclusion of complementary and OTC
therapy, referrals, and other team members needed to complete patient care.
Use at least one scholarly source other than your textbook to connect your response to
national guidelines and evidence-based research in support of your ideas.
3. You have a 9-year-old female patient who was newly diagnosed with
hypothyroidism last month. She is here to see you for a well-child exam. The mother
states that she has not filled the prescription because she wants to see if acupuncture
and herbal remedies will work first.
• How should you approach the mother on her use of complementary therapy?
• What should you tell the mother about the need for levothyroxine medication?
• What does the evidence say about acupuncture as a complementary therapy for
chronic diseases?
When dealing with a 9-year-old female patient who was newly diagnosed with hypothyroidism and whose mother is considering complementary therapies, it’s important to take a comprehensive and evidence-based approach to patient care. Here’s how I would approach this situation:
1. Gather Information:
Before discussing complementary therapy and treatment options, I would gather relevant information through a combination of questions, physical examination, and further testing.
Questions to Ask the Patient and Mother:
- Gather the patient’s medical history, including symptoms, duration, and any associated factors.
- Inquire about any family history of thyroid disorders or other relevant medical conditions.
- Ask about the patient’s current diet, exercise, and sleep patterns.
- Discuss any symptoms of hypothyroidism the patient may have experienced since the diagnosis.
- Explore the mother’s beliefs and understanding of complementary therapies and her reasons for wanting to try acupuncture and herbal remedies.
Physical Examination: Conduct a thorough physical examination, focusing on:
- Growth assessment, including height and weight.
- Vital signs, including heart rate and blood pressure.
- Examination of the thyroid gland for enlargement or tenderness.
- Assessment of any physical signs of hypothyroidism, such as dry skin, hair changes, and facial puffiness.
Further Testing: Consider ordering or reviewing the following tests:
- Thyroid function tests (TSH and free T4) to assess the patient’s current thyroid status.
- Bone age assessment to monitor growth and development.
- Lipid profile to assess cardiovascular risk.
2. Approach to Complementary Therapy:
When discussing complementary therapy, approach the mother with empathy and open communication. Acknowledge her concerns and desire to explore alternative options. However, emphasize the importance of evidence-based medical treatment for hypothyroidism and its potential consequences if left untreated or undertreated.
3. Importance of Levothyroxine Medication:
Explain to the mother that levothyroxine is a synthetic form of the thyroid hormone that her daughter’s body needs. Without proper thyroid hormone levels, her daughter’s growth, development, and overall health could be negatively affected. Provide clear information about the benefits of medication in addressing hypothyroidism and preventing complications.
4. Evidence on Acupuncture as Complementary Therapy:
According to the National Center for Complementary and Integrative Health (NCCIH), acupuncture has been studied for various conditions, including chronic pain and some chronic diseases. While there is some evidence suggesting potential benefits of acupuncture for certain conditions, its effectiveness as a complementary therapy for hypothyroidism specifically is not well-established. It is important to inform the mother that acupuncture should not be considered a substitute for levothyroxine medication, and any complementary therapy should be discussed and coordinated with the medical treatment plan.
5. Treatment Plan:
- Initiate levothyroxine medication to manage hypothyroidism and ensure proper thyroid hormone levels.
- Schedule regular follow-up visits to monitor the patient’s thyroid function, growth, and overall health.
- Provide dietary and lifestyle recommendations to support the patient’s well-being.
- Encourage the mother to communicate openly about any complementary therapies she wishes to explore, ensuring they are safe and do not interfere with the medical treatment.
6. Referrals and Team Collaboration:
Collaboration with other healthcare providers may be necessary:
- Consult an endocrinologist for specialized guidance on managing pediatric hypothyroidism.
- Collaborate with a pediatrician or primary care physician to ensure comprehensive care.
7. Education and Resources:
Offer educational materials and reputable resources to the mother about hypothyroidism, its treatment, and complementary therapies. Encourage the mother to make informed decisions based on evidence-based information.
Evidence-Based Source:
For information on acupuncture as a complementary therapy, you can refer to the National Center for Complementary and Integrative Health (NCCIH) website (nccih.nih.gov) and explore their research and publications on acupuncture and its applications in chronic diseases. This source can provide valuable insights into the evidence base for acupuncture and guide your discussion with the patient’s mother.
Remember, patient-centered care involves respectful communication, evidence-based recommendations, and a collaborative approach to ensure the best possible outcomes for the patient’s health and well-being.