Before I start discussing specifics about the condition, I will first acknowledge her concerns and empathize with her because clearly,

Before I start discussing specifics about the condition, I will first acknowledge her concerns and empathize with her because clearly, she has an array of things that are overwhelmingly concerning for her, causing her distress. I will most likely ask her regarding the details surrounding her symptoms and job. Was it her symptoms that caused her to lose her job? Is she stressed from her symptoms or from losing her job or both? Allowing her some time to share or vent her feelings and letting her see that as a provider, I am concerned about her whole being, may help her be more receptive to the information and education I am about to divulge. Hypothyroidism is a common chronic pathological condition of thyroid hormone deficiency – thyroxine (T4) and triiodothyronine (T3). It is one of the most common diseases worldwide and it affects women more commonly than men, with its incidence increasing with age, peaking at around age 30 to 50 (Chiovato, Magri, Carlé, 2019) and Melina belongs to this age group. Hypothyroidism is also common in patients with autoimmune diseases such as T1DM, autoimmune gastric atrophy, and celiac disease (Chiovato, Magri, Carlé, 2019). If left untreated, it can demonstrate a range of symptoms, decrease one’s quality of life, and potentially be fatal in severe cases.            Hypothyroidism results from the low levels of thyroid hormones and is classified as primary, secondary, tertiary, and peripheral based on the etiology. Primary is due to the inability of the thyroid gland to produce adequate amounts of thyroid hormones, secondary has to do with TSH deficiency resulting from a pituitary gland pathology, tertiary results when there is a defect within the hypothalamus leading to thyrotropin-releasing hormone deficiency, and peripheral is a permanent congenital hypothyroidism due to defects in the thyroid hormone metabolism (Chaker, et. al, 2017). We know that Melina has hypothyroidism due to her TSH level of 8 (normal is around 0.5-5.0 mU/L). TSH levels indicate the thyroid gland function. When levels are high, it indicates that the thyroid is not making enough thyroid hormones. Alternatively, when the TSH is low, it means that the thyroid is making too much thyroid hormone. I would also explain to her that adding a free T4 blood test will aid in determining the type of hypothyroidism she has. The free T4 measures unbound thyroid hormones that can affect the body (American Thyroid Association, 2021). When free T4 levels are low, coupled with high TSH, it indicates primary hypothyroidism, whereas when free T4 levels are low, coupled with low TSH, it indicates secondary hypothyroidism. Additionally, for the purpose of treatment, knowing the free T4 levels can help determine whether Melina has overt or subclinical hypothyroidism. Overt is characterized by elevated TSH and low T4 while subclinical is a milder form where only the TSH in abnormal and there is controversy whether this should be treated in non-pregnant adults (Chiovato, Magri, Carlé, 2019).            It is necessary to make Melina aware that upon diagnosis of hypothyroid based on its clinical features along with biochemical confirmation of overt hypothyroidism, this serves as an indication for treatment. Lifelong monotherapy using levothyroxine will be initiated, unless the reason for the hypothyroidism is due to transient forms of thyroiditis, iodine deficiency, or drugs where appropriate actions to correct the cause of insult can be addressed and subsequently relieve symptoms and correct thyroid levels (Chaker, et. al, 2017). The goal of levothyroxine treatment is to reduce symptoms and prevent long-term complications. Untreated hypothyroidism can manifest with symptoms such as weight gain, fatigue, poor concentration, depression, menstrual irregularities, lethargy, cold intolerance, constipation, and dry skin (Patil, Rehman,