Thyroid Disorder Management: Patient Care Plan

Patient Information

• Name: _________________
• Date: _________________
• Diagnosis: _________________

Monitoring Schedule

Laboratory Tests

• TSH levels every ____ months
• Free T4 levels every ____ months
• Free T3 levels (if applicable) every ____ months
• Thyroid antibodies (if applicable) every ____ months

Medication Management

Current Medications

1. Primary thyroid medication: _________________
   • Dosage: _________________
   • Frequency: _________________
2. Supporting medications: _________________

Medication Instructions

• Take thyroid medication on an empty stomach
• Wait 30-60 minutes before eating
• Avoid calcium/iron supplements within 4 hours

Lifestyle Modifications

Diet Guidelines

• Maintain consistent iodine intake
• Monitor calcium and vitamin D intake
• Limit goitrogenic foods if applicable

Physical Activity

• Type: _________________
• Frequency: _________________
• Duration: _________________

Symptom Monitoring

Track These Symptoms

• Energy levels
• Weight changes
• Body temperature sensitivity
• Heart rate/palpitations
• Mood changes
• Sleep patterns

Emergency Protocol

Contact Your Doctor If:

• Severe palpitations occur
• Extreme fatigue develops
• Unusual weight changes
• Severe anxiety or depression

Follow-up Schedule

• Next appointment: _________________
• Endocrinologist visit: _________________
• Primary care visit: _________________

Additional Notes

Healthcare Team Contacts

• Endocrinologist: _________________
• Primary Care: _________________
• Pharmacy: _________________