NR 565 VERIFIED EXAM QUESTIONS AND ANSWERS
Signs and symptoms of hypothyroidism
Face is pale, puffy, and expressionless.
Skin is cold and dry.
hair is brittle, and hair loss occurs.
Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance
to cold.
Mentation may be impaired.
Signs and symptoms of hyperthyroidism
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
Myxedema
Hypothyroid Treatment
Levothyroxine is the drug of choice for most patients who require thyroid hormone
replacement.
Levothyroxine (Synthroid) Therapeutic Goal
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
Graves disease and toxic nodular goiter (also known as Plummer disease).
Graves Disease
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?
, 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
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
thionamide drugs—methimazole and propylthiouracil (PTU)—suppress synthesis of
thyroid hormones.
Methimazole Therapeutic Goal
(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
Check CBC with differential if signs or symptoms of infection. Check LFTs if signs or
symptoms of liver dysfunction.
High Risk Patients for Methimazole
Should be avoided in the first trimester of pregnancy.
Methimazole Toxicity
Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning
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.
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
Signs and symptoms of hypothyroidism
Face is pale, puffy, and expressionless.
Skin is cold and dry.
hair is brittle, and hair loss occurs.
Heart rate and temperature are lowered. The patient lethargy, fatigue, and intolerance
to cold.
Mentation may be impaired.
Signs and symptoms of hyperthyroidism
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
Myxedema
Hypothyroid Treatment
Levothyroxine is the drug of choice for most patients who require thyroid hormone
replacement.
Levothyroxine (Synthroid) Therapeutic Goal
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
Graves disease and toxic nodular goiter (also known as Plummer disease).
Graves Disease
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?
, 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
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
thionamide drugs—methimazole and propylthiouracil (PTU)—suppress synthesis of
thyroid hormones.
Methimazole Therapeutic Goal
(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
Check CBC with differential if signs or symptoms of infection. Check LFTs if signs or
symptoms of liver dysfunction.
High Risk Patients for Methimazole
Should be avoided in the first trimester of pregnancy.
Methimazole Toxicity
Agranulocytosis is the most dangerous toxicity.
PTU High Risk Warning
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.
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
