(NOTE: This case study is 100% fictitious, and is not on an actual person, but this case study I created is designed for educational and informative purposes as a possible real-life example)
X is a 25-year old man who goes to the pharmacy with a new prescription for Methimazole. He tells the pharmacist he got diagnosed with Graves’ disease, an autoimmune thyroid disorder in which the antibodies affect the thyroid gland which results in hyperthyroidism. The man tells the pharmacist that his grandmother was diagnosed with hypothyroidism and that she also takes methimazole. X is concerned that he may have been prescribed the wrong medication, and X worries that taking the medication may worsen the hyperthyroidism which will affect his ability to maintain employment.
II. RYAN’S ANALYSIS:
Let’s review the case study. X, a 25-year old man was prescribed methimazole for Graves’ disease. Methimazole is the correct medication for a person with Graves’ disease. Methimazole is an anti-thyroid medication that is taken orally (in pill form) to reduce the production of thyroid hormones being distributed to the thyroid gland in order to stabilize thyroid stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3), and to regulate efficient metabolic functioning.
X, however, stated to the pharmacist that his grandmother was diagnosed with hypothyroidism, and that she is also taking methimazole, and that X is worried he was prescribed the wrong medication (which we now know he was not), and that the methimazole will worsen his symptoms associated with his hyperthyroidism. Given these statements, the pharmacist would likely express concern to X’s grandmother as given her diagnosis of hypothyroidism as X stated, she should not be taking methimazole. Methimazole is an anti-thyroid medication prescribed to reduce thyroid hormone production. If the grandmother continues to take methimazole, her hypothyroidism would worsen which could result in cardiovascular issues, peripheral neuropathy, and musculoskeletal problems, which could eventually lead to myxedema coma and possible death. Methimazole would elevate TSH (too little thyroid hormone) and decrease T4 (least metabolically active form of thyroid hormone) and T3 (most metabolically active form of thyroid hormone) which could be dangerous for the grandmother. The pharmacist in this scenario would likely recommend that X speak to his grandmother about her stopping methimazole and having her speak to her primary care doctor or endocrinologist to be prescribed levothyroxine, not methimazole. Levothyroxine is the correct medication to prescribe as this medication (which is thyroid hormone replacement) is prescribed to people with hypothyroidism to help elevate the production of thyroid hormones to help stabilize thyroid stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3) to regulate metabolic functioning.
The pharmacist would also recommend to X that although he is taking the correct medication for his thyroid condition, he should always communicate his health concerns and needs with his primary care doctor or endocrinologist. The primary care doctor or endocrinologist can place orders for X’s thyroid panel to be evaluated to determine if X is on the right dose of methimazole, or, if X needs an adjustment in his dosage of methimazole, or in some cases, an additional agent such as a beta blocker if X were to experience palpitations.
III. RYAN’S KEY POINTS FROM CASE STUDY AND ANALYSIS:
1.) Know the medication you are being prescribed (and the dosage) by your doctor or medical specialist. Do research. Why were you prescribed the medication? What side effects or symptoms should you be aware of? Make sure it is the correct medication.
2.) If you realize someone you know well has a medical condition, and a medical professional state that they are taking the wrong medication, be honest with that person as you are saving a life instead of promoting a fatality. Have the person contact their doctor or medical specialist to inform them of the wrong prescription. If that person is experiencing serious side effects or any life-threatening symptoms, get them medical help right away by calling 911 and/or bringing them to their local emergency room.
3.) If you are experiencing symptoms and your body does not feel right with the medication you were prescribed and are taking, then talk with your doctor or medical professional about getting labs done to determine if a dose adjustment or a change in medication is needed to alleviate or eliminate the symptoms the person is experiencing.
4.) Methimazole is prescribed for people with hyperthyroidism (too much thyroid hormone).
a.) Goal of methimazole is to reduce thyroid production to stabilize thyroid hormone levels, and properly regulate metabolism
5.) Levothyroxine is prescribed for people with hypothyroidism (too little thyroid hormone).
a.) Goal of levothyroxine is to increase thyroid hormone production to stabilize thyroid hormone levels, and properly regulate metabolism