Page 1 of 1: Hypothyroidism

goldenhand · Credits: 19368 My Scrapbook

A 56-year-old woman with a long history of hypothyroidism comes for a routine clinic appointment. She is concerned that her hypothyroidism is getting worse. Although her symptoms had been well controlled previously with supplemental levothyroxine, over the last 6 months she has noticed increasing malaise, weight gain, and temperature intolerance, all symptoms that she suffered from before starting treatment. She reports taking her medications as prescribed and has had no major illness over the past year. Her only recent medical problems have involved getting her LDL-cholesterol under control. This goal has been met, however, though it required the addition of cholestyramine in addition to the statin she was taking already. Which of the following is the most likely underlying cause of this patient’s symptoms?

A. Coexisting major depressive disorder mimicking hypothyroid state

B. Dietary indiscretion resulting in reduced drug absorption and utilization

C. Drug interaction with cholestyramine resulting in reduced bioavailable levothyroxine

D. Natural progression of thyroid disease; patients require more medication over time

E. Occult malignancy or illness resulting in increased utilization of thyroid hormone

anupamaJK · Credits: 2385 My Scrapbook

C. Drug interaction with cholestyramine resulting in reduced bioavailable levothyroxine

goldenhand · Credits: 19368 My Scrapbook

Very good Dr.Anupama
The correct answer is C. Cholestyramine is a bile acid sequestrant that can lower LDL-cholesterol and modestly increase HDL-cholesterol when combined with a statin. In addition to binding bile acids in the gut lumen, cholestyramine also can bind other medications, resulting in reduced absorption and availability of the medication.

caillou · Credits: 2617 My Scrapbook

C. Drug interaction with cholestyramine resulting in reduced bioavailable levothyroxine

coffeee · Credits: 590 My Scrapbook

hi which exam is this q from ?

goldenhand · Credits: 19368 My Scrapbook

These were not exam questions ,but were taken from some highly regarded source books like Harrison's self assessment,UW,Lange series etc.

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