~!@#)_________!#~@Page
___!#~@Page
@~~!@#)_________!#~@Page
1 of 1810/5/2026,
1 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
1 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.d
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_
NR565 Final Study Guide
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 5
• Thyroid
o Diagnosis & Evaluation
▪ What labs are used to diagnose?
- Serum TSH levels = most sensitive for detecting hypothyroidism
- TSH level > 6 is indicative of hypothyroidism
- 0.3-6 is normal TSH level
- Measuring total or free T4 (free T4 is preferred)
▪ Timeframe for re-check of labs after starting levothyroxine
- Need to recheck TSH levels 6-8 weeks after initiating therapy
AND at any dosage change
- Need to monitor therapeutic effects and takes 1 month to establish
plasma levels
▪ Signs and symptoms of hypo and hyperthyroidism
- HYPOTHYROIDISM
- Can be caused by sx removal of thyroid
- Insufficient iodine in diet
- Autoimmune – Hashimoto’s dx
- Tx is lifelong
- T3 and T4 levels going to be low and TSH will be high
o Puffy and pale face
o Cold/dry skin
o Brittle hair
o Hair loss
o HR and temp lowered (bradycardia)
o Lethargy and fatigue
o Intolerance to cold
o Weight gain
o Constipation
o Depression
- HYPERTHRYOIDISM
o Graves’ disease or toxic nodular goiter (plummer dz)
▪ Overactive thyroid
▪ Excessive thyroid secretion due to autoimmune
process attacking thyroid
o TSH levels going to be low and T3/T4 going to be high
o Rapid/ strong HR
o Increased risk of dysrhythmias
o Nervousness
o Insomnia
o Rapid speech
___!#~@Page
Page 11 of
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AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
,~!@#)_________!#~@Page
___!#~@Page
@~~!@#)_________!#~@Page
2 of 1810/5/2026,
2 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
2 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.d
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_
NR565 Final Study Guide
o Weakened muscles/atrophy
o Increase body temp
o Intolerance to heat
o Increased appetite
o Diarrhea
o Exomphalos can occur = bulging eyes
▪ Dry eye can occur
o Treatment
▪ Treatment of thyroid storm – excessive levels of thyroid hormone
- Pt. experiences:
o Hyperthermia
o Severe tachycardia
o Restlessness / agitation
o Tremors
** can lead to coma and death AND hypotension which can lead to heart failure
- Can occur when undergoing surgery or with major illness
- Pt. is given high dose of potassium iodide to suppress TH release
- Methimazole (tapazole) given to suppress TH synthesis
- BB given to reduce HR
- May also initiative IV fluids, cooling, sedation, corticosteroids
▪ Result of not treating hypothyroidism during pregnancy
- May cause permanent neuropsychological deficits
- Can reduce child IQ
- Dose of thyroid medication needs to be increased by about 50%
especially in 1st trimester
▪ Medication to treat symptoms of hyperthyroidism (notice this is
treating symptoms and not the hyperthyroidism itself)
- Methimazole = first line drug for tx of the disease
o Block TH synthesis
o Prevents oxidation of iodide
o Toxicity = agranulocytosis (sore throat and fever)
▪ Need to monitor CBC for WBC count for infection
▪ Need LFT for hepatic function
o Not indicated for pregnancy. Would use PTU instead
o Tx will last 1-2 years
- Surgery to remove thyroid
- Radioactive iodine
- BB to reduce HR
▪ Drug/Food/Supplement interactions with levothyroxine
• ** these medications reduce the absorption of levothyroxine
▪
- Histamine 2 receptor blockers
- PPI
- Sucralfate
___!#~@Page
Page 22 of
of 1810/5/2026,
1810/5/2026, 5:02:10
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
,~!@#)_________!#~@Page
___!#~@Page
@~~!@#)_________!#~@Page
3 of 1810/5/2026,
3 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
3 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.d
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_
NR565 Final Study Guide
- Cholestyramine
- Colestipol
- Aluminum containing antacids
- Calcium supplements
- Iron supplements
- Magnesium salts
- Orlistat
** these medications accelerate levothyroxine metabolism
- Phenytoin
- Carbamazepine
- Sertraline
- Rifampin
- Catecholamines
- ** insulin digoxin, and warfarin may need to be increased if pt.
takes these
• Synthroid dose
o 100 – 125 mcg in adults
o 25- 50 mcg in older adults because of slower metabolism by liver
▪ Elderly can experience palpitations with Synthroid
o Medication should be taken on an empty stomach, 30 minutes before a meal and
in the morning
▪ Taking at nighttime can keep patients awake
o May develop thyroid toxicosis from Synthroid
▪ Tachycardia
▪ Angina
▪ Tremors
▪ Nervousness
▪ Insomnia
▪ Sweating
▪ Heat intolerance
• Diabetes
o How to confirm a diagnosis prior to beginning treatment
- Fasting plasma glucose > or equal to 126
- Random plasma glucose > or equal to 200 PLUS symptoms of
diabetes
- Oral glucose tolerance test: 2-h plasma glucose > or equal to 200
** patient must be tested on two separate days and a combo of
either test can confirm diagnosis if they are BOTH positive
- A1C 6.5% or higher
- Pre-diabetes is 5.7% - 6.4%
o A1C
▪ General goals
- Considered the standard test for diabetes
- Keep A1C less than 7%
- Reflect glucose levels from previous 2-3 months
___!#~@Page
Page 33 of
of 1810/5/2026,
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AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
___!#~@Page
@~~!@#)_________!#~@Page
1 of 1810/5/2026,
1 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
1 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.d
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_
NR565 Final Study Guide
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Week 5
• Thyroid
o Diagnosis & Evaluation
▪ What labs are used to diagnose?
- Serum TSH levels = most sensitive for detecting hypothyroidism
- TSH level > 6 is indicative of hypothyroidism
- 0.3-6 is normal TSH level
- Measuring total or free T4 (free T4 is preferred)
▪ Timeframe for re-check of labs after starting levothyroxine
- Need to recheck TSH levels 6-8 weeks after initiating therapy
AND at any dosage change
- Need to monitor therapeutic effects and takes 1 month to establish
plasma levels
▪ Signs and symptoms of hypo and hyperthyroidism
- HYPOTHYROIDISM
- Can be caused by sx removal of thyroid
- Insufficient iodine in diet
- Autoimmune – Hashimoto’s dx
- Tx is lifelong
- T3 and T4 levels going to be low and TSH will be high
o Puffy and pale face
o Cold/dry skin
o Brittle hair
o Hair loss
o HR and temp lowered (bradycardia)
o Lethargy and fatigue
o Intolerance to cold
o Weight gain
o Constipation
o Depression
- HYPERTHRYOIDISM
o Graves’ disease or toxic nodular goiter (plummer dz)
▪ Overactive thyroid
▪ Excessive thyroid secretion due to autoimmune
process attacking thyroid
o TSH levels going to be low and T3/T4 going to be high
o Rapid/ strong HR
o Increased risk of dysrhythmias
o Nervousness
o Insomnia
o Rapid speech
___!#~@Page
Page 11 of
of 1810/5/2026,
1810/5/2026, 5:02:10
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
,~!@#)_________!#~@Page
___!#~@Page
@~~!@#)_________!#~@Page
2 of 1810/5/2026,
2 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
2 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.d
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_
NR565 Final Study Guide
o Weakened muscles/atrophy
o Increase body temp
o Intolerance to heat
o Increased appetite
o Diarrhea
o Exomphalos can occur = bulging eyes
▪ Dry eye can occur
o Treatment
▪ Treatment of thyroid storm – excessive levels of thyroid hormone
- Pt. experiences:
o Hyperthermia
o Severe tachycardia
o Restlessness / agitation
o Tremors
** can lead to coma and death AND hypotension which can lead to heart failure
- Can occur when undergoing surgery or with major illness
- Pt. is given high dose of potassium iodide to suppress TH release
- Methimazole (tapazole) given to suppress TH synthesis
- BB given to reduce HR
- May also initiative IV fluids, cooling, sedation, corticosteroids
▪ Result of not treating hypothyroidism during pregnancy
- May cause permanent neuropsychological deficits
- Can reduce child IQ
- Dose of thyroid medication needs to be increased by about 50%
especially in 1st trimester
▪ Medication to treat symptoms of hyperthyroidism (notice this is
treating symptoms and not the hyperthyroidism itself)
- Methimazole = first line drug for tx of the disease
o Block TH synthesis
o Prevents oxidation of iodide
o Toxicity = agranulocytosis (sore throat and fever)
▪ Need to monitor CBC for WBC count for infection
▪ Need LFT for hepatic function
o Not indicated for pregnancy. Would use PTU instead
o Tx will last 1-2 years
- Surgery to remove thyroid
- Radioactive iodine
- BB to reduce HR
▪ Drug/Food/Supplement interactions with levothyroxine
• ** these medications reduce the absorption of levothyroxine
▪
- Histamine 2 receptor blockers
- PPI
- Sucralfate
___!#~@Page
Page 22 of
of 1810/5/2026,
1810/5/2026, 5:02:10
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
,~!@#)_________!#~@Page
___!#~@Page
@~~!@#)_________!#~@Page
3 of 1810/5/2026,
3 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
3 of 1810/5/2026,
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.d
5:02:10 AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_
NR565 Final Study Guide
- Cholestyramine
- Colestipol
- Aluminum containing antacids
- Calcium supplements
- Iron supplements
- Magnesium salts
- Orlistat
** these medications accelerate levothyroxine metabolism
- Phenytoin
- Carbamazepine
- Sertraline
- Rifampin
- Catecholamines
- ** insulin digoxin, and warfarin may need to be increased if pt.
takes these
• Synthroid dose
o 100 – 125 mcg in adults
o 25- 50 mcg in older adults because of slower metabolism by liver
▪ Elderly can experience palpitations with Synthroid
o Medication should be taken on an empty stomach, 30 minutes before a meal and
in the morning
▪ Taking at nighttime can keep patients awake
o May develop thyroid toxicosis from Synthroid
▪ Tachycardia
▪ Angina
▪ Tremors
▪ Nervousness
▪ Insomnia
▪ Sweating
▪ Heat intolerance
• Diabetes
o How to confirm a diagnosis prior to beginning treatment
- Fasting plasma glucose > or equal to 126
- Random plasma glucose > or equal to 200 PLUS symptoms of
diabetes
- Oral glucose tolerance test: 2-h plasma glucose > or equal to 200
** patient must be tested on two separate days and a combo of
either test can confirm diagnosis if they are BOTH positive
- A1C 6.5% or higher
- Pre-diabetes is 5.7% - 6.4%
o A1C
▪ General goals
- Considered the standard test for diabetes
- Keep A1C less than 7%
- Reflect glucose levels from previous 2-3 months
___!#~@Page
Page 33 of
of 1810/5/2026,
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AM&@*&#^*^($(@*^$&*&(*^$$&$&*$^^&&@&*^$&^20240402132122_660c0652703cd_565_final_exam_study_guide.docx
