NR565 FINAL EXAM SCRIPT UPDATED
COMPLETE QUESTIONS AND ANSWERS
EXPERT REVIEWED
●● Signs and symptoms of hyperthyroidism
Answer: Heart Rate is Rapid; Possible arrhythmia/angina
Nervousness, insomnia, rapid thought flow, and rapid speech
Skeletal muscles may weaken and atrophy
Metabolic rate is raised, resulting in increased heat production, increased
body temperature, intolerance to heat, and skin that is warm and moist
Weight loss occurs if caloric intake fails to match the increase in
metabolic rate
●● Severe hypothyroidism
Answer: Myxedema
●● Hypothyroid Treatment
Answer: Levothyroxine is the drug of choice for most patients who
require thyroid hormone replacement.
●● Levothyroxine (Synthroid) Therapeutic Goal
,Answer: Resolution of signs and symptoms of hypothyroidism and
restoration of normal laboratory values for serum thyroid-stimulating
hormone (TSH) and free thyroxine (T4).
●● Major forms of hyperthyroidism
Answer: Graves disease and toxic nodular goiter (also known as
Plummer disease).
●● Graves Disease
Answer: Most common cause of excessive thyroid hormone secretion
●● What adjunctive therapy is good to prescribe to control symptoms of
hyperthyroidism other than thyroid specific medications?
Answer: β-Blockers and nonradioactive iodine may be used as
adjunctive therapy.
β-Blockers suppress tachycardia by blocking β-receptors on the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid
hormones.
●● Monitoring needs and intervals for Levothyroxine
Answer: Check TSH 6-8 weeks after initiating therapy and after any
dosage change.
Check TSH at least once a year after serum TSH is stabilized.
,●● Hyperthyroid Treatment
Answer: thionamide drugs—methimazole and propylthiouracil (PTU)—
suppress synthesis of thyroid hormones.
●● Methimazole Therapeutic Goal
Answer: (1) reduction of thyroid hormone production in Graves' disease,
(2) control of hyperthyroidism until the effects of radiation on the
thyroid become manifest, (3) suppression of thyroid hormone production
before subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
●● Monitoring needs and intervals for Methimazole
Answer: Check CBC with differential if signs or symptoms of infection.
Check LFTs if signs or symptoms of liver dysfunction.
●● High Risk Patients for Methimazole
Answer: Should be avoided in the first trimester of pregnancy.
●● Methimazole Toxicity
Answer: Agranulocytosis is the most dangerous toxicity.
●● PTU High Risk Warning
Answer: Carries a risk for liver toxicity. Although rare, the FDA
recommends against using as a first-line treatment due to potential for
hepatic toxicity.
, ●● Effects of maternal hypothyroidism on offspring and appropriate
patient teaching related to need for treatment.
Answer: Can cause delay in mental development and derangement of
growth. In the absence of thyroid hormones, the child develops a large
and protruding tongue, potbelly, and dwarfish stature. Development of
the nervous system, bones, teeth, and muscles is impaired.
●● Congenital Hypothyroidism Treatment
Answer: requires replacement therapy with thyroid hormones. If
treatment is initiated within a few days of birth, physical and mental
development will be normal.
replacement therapy should continue for 3 years, after which it should be
stopped for 4 weeks to determine whether thyroid deficiency is
permanent or transient.
●● Patient Teaching for Methimazole
Answer: Tell your healthcare providers that you are taking this drug.
Check blood work as directed.
Taking this drug may cause harm to the unborn baby if you are pregnant,
especially in the first trimester.
If you are pregnant or become pregnant while taking this drug, call your
healthcare provider right away.
COMPLETE QUESTIONS AND ANSWERS
EXPERT REVIEWED
●● Signs and symptoms of hyperthyroidism
Answer: Heart Rate is Rapid; Possible arrhythmia/angina
Nervousness, insomnia, rapid thought flow, and rapid speech
Skeletal muscles may weaken and atrophy
Metabolic rate is raised, resulting in increased heat production, increased
body temperature, intolerance to heat, and skin that is warm and moist
Weight loss occurs if caloric intake fails to match the increase in
metabolic rate
●● Severe hypothyroidism
Answer: Myxedema
●● Hypothyroid Treatment
Answer: Levothyroxine is the drug of choice for most patients who
require thyroid hormone replacement.
●● Levothyroxine (Synthroid) Therapeutic Goal
,Answer: Resolution of signs and symptoms of hypothyroidism and
restoration of normal laboratory values for serum thyroid-stimulating
hormone (TSH) and free thyroxine (T4).
●● Major forms of hyperthyroidism
Answer: Graves disease and toxic nodular goiter (also known as
Plummer disease).
●● Graves Disease
Answer: Most common cause of excessive thyroid hormone secretion
●● What adjunctive therapy is good to prescribe to control symptoms of
hyperthyroidism other than thyroid specific medications?
Answer: β-Blockers and nonradioactive iodine may be used as
adjunctive therapy.
β-Blockers suppress tachycardia by blocking β-receptors on the heart.
Nonradioactive iodine inhibits synthesis and release of thyroid
hormones.
●● Monitoring needs and intervals for Levothyroxine
Answer: Check TSH 6-8 weeks after initiating therapy and after any
dosage change.
Check TSH at least once a year after serum TSH is stabilized.
,●● Hyperthyroid Treatment
Answer: thionamide drugs—methimazole and propylthiouracil (PTU)—
suppress synthesis of thyroid hormones.
●● Methimazole Therapeutic Goal
Answer: (1) reduction of thyroid hormone production in Graves' disease,
(2) control of hyperthyroidism until the effects of radiation on the
thyroid become manifest, (3) suppression of thyroid hormone production
before subtotal thyroidectomy, (4) treatment of thyrotoxic crisis.
●● Monitoring needs and intervals for Methimazole
Answer: Check CBC with differential if signs or symptoms of infection.
Check LFTs if signs or symptoms of liver dysfunction.
●● High Risk Patients for Methimazole
Answer: Should be avoided in the first trimester of pregnancy.
●● Methimazole Toxicity
Answer: Agranulocytosis is the most dangerous toxicity.
●● PTU High Risk Warning
Answer: Carries a risk for liver toxicity. Although rare, the FDA
recommends against using as a first-line treatment due to potential for
hepatic toxicity.
, ●● Effects of maternal hypothyroidism on offspring and appropriate
patient teaching related to need for treatment.
Answer: Can cause delay in mental development and derangement of
growth. In the absence of thyroid hormones, the child develops a large
and protruding tongue, potbelly, and dwarfish stature. Development of
the nervous system, bones, teeth, and muscles is impaired.
●● Congenital Hypothyroidism Treatment
Answer: requires replacement therapy with thyroid hormones. If
treatment is initiated within a few days of birth, physical and mental
development will be normal.
replacement therapy should continue for 3 years, after which it should be
stopped for 4 weeks to determine whether thyroid deficiency is
permanent or transient.
●● Patient Teaching for Methimazole
Answer: Tell your healthcare providers that you are taking this drug.
Check blood work as directed.
Taking this drug may cause harm to the unborn baby if you are pregnant,
especially in the first trimester.
If you are pregnant or become pregnant while taking this drug, call your
healthcare provider right away.
