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DISCUSSION POST # 1 Reply to Ella

1- Iron-deficiency anemia

Based on the patient’s presentation and laboratory results, my assessment is that the patient has iron-deficiency anemia as evidence by her symptoms, low MCV, MCH, serum ferritin and serum iron. This could be because of several factors, such as gastrointestinal bleeding, menstrual bleeding, inadequate iron intake, or malabsorption. Knowing the possible diagnosis, I would ask the patient the following questions taken in consideration her medical history, current symptoms and also her lifestyle. First question will be is she has noticed any changes or heavy bleeding during her menstrual cycle. Any unexplained shortness of breath. Any hair loss or brittle nails. Any history of as ulcers, Crohn’s disease, or celiac disease. Another key question during the assessment is to ask the patient if she is vegetarian. According to (Pawlak et al., 2018), vegetarians are at a high risk of a deficiency of some nutrients, such as vitamin B12 and iron. In vegetarians, risk of iron deficiency is related to both inadequate iron intake and low bioavailability of iron from plant foods.(Pawlak et al., 2018).

Before prescribing an iron medication, further blood work for hemoglobin electrophoresis will be conducted to rule out other genetic conditions, such as thalassemia. The patient was adopted and had no information about her family’s history. According to (Benz & Angelucci, 2023), individuals with thalassemia have variable degrees of anemia and extramedullary hematopoiesis, which in turn can cause bone changes, impaired growth, and iron overload.

Following all the tests, I will start the patient on an iron supplement, such as ferrous sulfate 65-130 mg PO per day for 2–6 months. The patient will receive instructions on how to take the iron effectively, like taking the iron supplement at least one hour before breakfast and on an empty stomach. The patient will also be informed on the advantages of taking iron supplements with vitamin C, as the vitamin C helps the body better absorb the iron, or she can eat oranges, strawberries or tomatoes. She will be instructed not to take any other iron, multivitamin supplements, antiacids or laxatives during the treatment. As mentioned by (Hailstone et al., 2021), clinically, proton pump inhibitor (PPI) administration has demonstrated decreases in iron absorption in iron-deficient patients

If taking supplements is not an option, another way to help the patient get more iron into her body is by changing her diet. Foods rich in iron include red meat, poultry, fish, beans, spinach, and cereals with iron added.

I will monitor the patient closely to make sure that the treatment plan is effective and to determine if I have to be more aggressive with current treatment if needed. Follow up will be in 1 month. And no referrals needed at this time.


DISCUSSION POST # 2 Reply to Thalia


Hypothyroidism is a likely diagnosis for this patient with a TSH level of 39. It is defined as a condition that results from the thyroid gland producing insufficient amounts of thyroid hormone to meet the needs of peripheral tissues (McDermott, 2020).  Common symptoms for hypothyroidism are related to reduced metabolic processes resulting in fatigue, cold intolerance, changes in the skin, and weight gain (Chaker et al., 2022)

Hypothyroidism – is a condition that results from the thyroid gland producing insufficient amounts of thyroid hormone with typical symptoms of fatigue, weight gain, and cold intolerance (Chaker et al., 2022).

The mainstay for hypothyroidism diagnosis is a thyroid function lab test that measures serum TSH levels (Chaker et al., 2022). Considering that symptoms of hypothyroidism are non-specific other lab test and diagnostics are recommended (McDermott, 2020). Current guidelines recommend treatment with thyroid hormone replacement for patients 70 years and younger who have TSH levels greater than 10 mU/L (McDermott, 2020).


Hypothyroidism is generally managed with the replacement of thyroid hormone using daily medication (National Institute of Diabetes and Digestive and Kidney Diseases & National Institutes of Health, 2021). Levothyroxine is a common medication prescribed for the replacement of thyroid hormone (Chaker et al., 2022).  Discuss and provide education regarding dietary supplements and nutritional considerations, such as iodine intake (National Institute of Diabetes and Digestive and Kidney Diseases & National Institutes of Health, 2021). Complete Diagnostic lab work, begin thyroid replacement – Levothyroxine 1.6 mcg/kg/day up to 200 mcg/day taken every am by mouth 1 hr. before a meal, and plan to schedule follow up lab work and exam in 4-6 weeks.