Gastrointestinal Bleeding and Possible Hypothyroidism

An 88-year-old female, living independently in the community, developed duodenal and gastric ulcers from using overthe-counter naproxen sodium for pain related to a shoulder fracture and arthritis of the knees. She was hospitalized and received packed red blood cells and intravenous proton pump inhibitor therapy. During her hospitalization, she developed atrial fibrillation (AF). Warfarin was not prescribed for stroke prevention because of the gastrointestinal (GI) bleeding. The patient was initially placed on atenolol, and then amiodarone was added. After a two-week hospital stay she was discharged to a nursing facility to gain strength, further correct her anemia, and receive physical therapy for the shoulder and ambulation problems from arthritis of the knees. The amiodarone was continued in the nursing facility. After 15 days of amiodarone therapy (hospital and nursing facility), a laboratory report indicated an elevated thyroid-stimulating hormone level. Levothyroxine was prescribed. The patient was eventually discharged to an assisted living facility once her strength returned and her ambulation improved. GI bleeding with anemia and weakness from nonsteroidal anti-inflammatory drug use and changes in thyroid function with amiodarone therapy for AF will be discussed.