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Patient profile
A.J is a 50-year-old housewife who complains of progressive weight gain of 20 pounds in 1 year, fatigue, postural dizziness, loss of memory, slow speech, deepening of her voice, dry skin, constipation, and cold intolerance.
Physical examination: Vital signs include a temperature of 96.8 °F, pulse 58/minute and regular, BP 110/60. She is moderately obese, speaks slowly, and has a puffy face with pale, cool, dry, and thick skin. The thyroid gland is not palpable. The deep tendon reflex time is delayed.

Laboratory studies:
CBC and differential WBC are normal.
The serum T4 concentration is 3.8 ug/dl (Normal = 4.5-12.5),
The serum TSH is 1 uU/ml (Normal = 0.2-3.5),
The serum cholesterol is 255 mg/dl (Normal <200). Discussion Questions 1. What are the priority patient teachings for levothyroxine? 2. Explain the importance of iodine in this patient’s diet.

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