Outpatient Case Study: Hyperthyroidism in Oncology Patient

Karina Almanza, CSUN Dietetic Intern 2017-2018

R.D., Nicole Del Guercio
David. X. Alvarez, Director and Elaine Stuart, Assistant Director
Kaiser Permanente, Woodland Hills CA
Introduction
R.B. is a 64 year old female. Formerly a breast cancer survivor, her consultation related to
nutrition with with a Registered Dietitian who specializes in oncology. R.B.’s current problems are
associated with hyperlipidemia, osteoarthritic, atherosclerosis of aorta, emphysema, follicular carcinoma
(thyroid) as well as history of depression, smoking, thyroid lobectomy and breast cancer located in the left
breast.
Hyperlipidemia implies a high level of one of the four main lipids that circulate through the blood
by attaching to proteins, chylomicron, VLDL, HDL, and LDL. Most of the time, hyperlipidemia is
associated with high levels of LDL cholesterol which is the lipid that is richest in cholesterol content.
Major risk factors include cigarette smoking, hypertension, HDL-C levels < 40 mg/dL, history of
premature CHD, and being over the age of 45 for men and over the age of 55 for women. Nutrition
therapy includes a decrease in saturated fats (<7% daily kcals), decrease in cholesterol (< 200 mg/day)
and an increase in plant stanols-sterols and fiber (10-25 g/day).
Characterized as a chronic and and slowly progressive, non-inflammatory disease, osteoarthritis is
characterized by the deterioration and abrasion of articular cartilage.(P p.1037) Even though the disease is
characterized as non-inflammatory, there have been recent studies that show evidence that there is
inflammation that occurs as cytokines and metalloproteinases are released into the joint. These cytokines
and metalloproteinases are furthermore involved in excessive matrix degradation that characterizes
cartilage degeneration in osteoarthritis. (NTP p. 758 ref 34) Treatment includes patient education on heat
and cold compresses, weight loss, exercise, physical therapy, occupational therapy, lessening the load on
certain joints; drug therapy focusing on use of NSAIDS, is implemented to relieve pain. In Europe,
Glucosamine and Chondroitin have been used as a dietary supplement for treating osteoarthritis. (NTP p.
758 red 40)
Atherosclerosis is generally defined as a thickening of the walls of the vessels and a conclusive
loss of vascular elasticity. For R.B., the development of atherosclerosis is specific to the aorta. The
progression of atherosclerosis can lead to infracts resulting in an myocardial infarction, a cerebrovascular
accident, and coronary heart disease; the latter two are two of the leading causes of death in the U.S..
Atherosclerosis can developed due to injury, chemical irritants such as tobacco, oxidized LDL, glycated
substances, angiotensin II which in turn decreases the level of nitric oxide. The imbalance of nitric oxide
plays a critical role in exacerbating the inflammatory state that contributes to the progression of
atherosclerosis. Nutrition therapy focuses on a decrease in total fat (20-35% of kcal/ day), saturated fat (<
7% of kcal/ day), trans fats (< 1% of kcal/ day), cholesterol (< 200 mg/ day) and an increase in physical
activity, monounsaturated fats, linolenic acid (1 g/ day), polyunsaturated fts (10% of kcal/ day), fiber (25
g/day: women 38g/day: men), folate and B12, plant sterols/ phytosterols, nuts and nutrition education.
(NTP pg 758)
Emphysema is the thinning and destruction of the alveoli, ultimately resulting in a decrease in
oxygen that is transferred into the bloodstream and a shortness of breath. (NTP p 636) Emphysema
typically develops over the years and is related to smoking. An important component of therapy is an
emphasis on exercising. (NTP p 644)
Follicular carcinoma (thyroid) is the identification of carcinoma particular to the thyroid region.
This ultimately is the reason for R.B. meeting with an R.D. prior to removal of the thyroid along with the
mass. Typically, radiation can be conducted to treat follicular carcinoma, as seen with iodine 131 which is
naturally absorbed by the thyroid. (NTP p. 695) The following the R.D. consult, R.B. is preparing for a
partial thyroidectomy.

Abstract
R.B. is a 64 yo female last seen on 12/7/2017 in oncology. She states that she is scheduled for
partial thyroidectomy on 12/11/2017. She has had surgery previously this year. She reports chronic stress/
health issues and concerns. She c/o undesired wt gain, hair loss, diarrhea, stress/ anxiety, and decrease in
PA. Pt wants to know what to eat to heal quickly and support immune functions, as well as what not to eat
following thyroidectomy. She read that she needs to watch the iodine in foods. She has d/c’d vit/min
supplements per pre-surgery orders. Pt was previously taking vit D and was told to take Vit C but did not.