Clinical Case Study: Management of Hypothyroidism and Iron Deficiency Anemia
in a 23-Year-Old Female
Assignment Instructions:
JS is a 23-year-old woman that presents with fatigue, poor concentration, and heavy
menstrual periods. Her labs today show TSH 20, MCV 76, MCHC 27, ferritin 11, TIBC
421, Hgb 11.8. Current medications include sumatriptan prn for migraine with aura and
drospirenone 4mg one tablet po daily prescribed by her pharmacist, as well as kelp,
chromium picolinate, turmeric, and green tea supplements daily. What treatment plan
would you implement for JS? What medication changes would you make? Include
complete medication order(s). How would you monitor the effectiveness of this plan, and
what patient education would you provide?
, Introduction and Case Summary
JS is a 23-year-old woman presenting with fatigue, poor concentration, and heavy
menstrual periods. Laboratory results indicate a thyroid-stimulating hormone (TSH) level
of 20 mIU/L, which is significantly elevated, suggesting primary hypothyroidism. The
presence of microcytic, hypochromic anemia (MCV 76 fL, MCHC 27 g/dL) with low
ferritin (11 ng/mL) and elevated total iron-binding capacity (TIBC 421 µg/dL) is
consistent with iron deficiency anemia (IDA). Together, these findings indicate
coexisting hypothyroidism and iron deficiency, likely secondary to menorrhagia. JS’s
current supplements and medications warrant review for interactions and efficacy.
Assessment and Diagnosis
The combination of elevated TSH and normal-to-low hemoglobin with low ferritin
suggests primary hypothyroidism and iron deficiency anemia. Hypothyroidism can
contribute to fatigue, cognitive slowing, and menstrual irregularities, while iron
deficiency exacerbates lethargy and poor concentration. JS’s heavy menses may be
contributing to iron depletion, and her use of kelp supplements (a source of iodine) may
further complicate thyroid function if taken in excess. Therefore, the final diagnoses are:
1. Primary hypothyroidism.
2. Iron deficiency anemia secondary to menorrhagia.
3. Medication-supplement interactions requiring adjustment.
Treatment Plan and Medication Orders
The treatment plan should address both hypothyroidism and iron deficiency anemia while
ensuring drug-supplement compatibility.
in a 23-Year-Old Female
Assignment Instructions:
JS is a 23-year-old woman that presents with fatigue, poor concentration, and heavy
menstrual periods. Her labs today show TSH 20, MCV 76, MCHC 27, ferritin 11, TIBC
421, Hgb 11.8. Current medications include sumatriptan prn for migraine with aura and
drospirenone 4mg one tablet po daily prescribed by her pharmacist, as well as kelp,
chromium picolinate, turmeric, and green tea supplements daily. What treatment plan
would you implement for JS? What medication changes would you make? Include
complete medication order(s). How would you monitor the effectiveness of this plan, and
what patient education would you provide?
, Introduction and Case Summary
JS is a 23-year-old woman presenting with fatigue, poor concentration, and heavy
menstrual periods. Laboratory results indicate a thyroid-stimulating hormone (TSH) level
of 20 mIU/L, which is significantly elevated, suggesting primary hypothyroidism. The
presence of microcytic, hypochromic anemia (MCV 76 fL, MCHC 27 g/dL) with low
ferritin (11 ng/mL) and elevated total iron-binding capacity (TIBC 421 µg/dL) is
consistent with iron deficiency anemia (IDA). Together, these findings indicate
coexisting hypothyroidism and iron deficiency, likely secondary to menorrhagia. JS’s
current supplements and medications warrant review for interactions and efficacy.
Assessment and Diagnosis
The combination of elevated TSH and normal-to-low hemoglobin with low ferritin
suggests primary hypothyroidism and iron deficiency anemia. Hypothyroidism can
contribute to fatigue, cognitive slowing, and menstrual irregularities, while iron
deficiency exacerbates lethargy and poor concentration. JS’s heavy menses may be
contributing to iron depletion, and her use of kelp supplements (a source of iodine) may
further complicate thyroid function if taken in excess. Therefore, the final diagnoses are:
1. Primary hypothyroidism.
2. Iron deficiency anemia secondary to menorrhagia.
3. Medication-supplement interactions requiring adjustment.
Treatment Plan and Medication Orders
The treatment plan should address both hypothyroidism and iron deficiency anemia while
ensuring drug-supplement compatibility.
