NR 565 FINAL EXAM CONCEPT REVIEW GUIDE
2026 PATIENT EVALUATION AND CLINICAL
DECISION MAKING
◉ 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.
2026 PATIENT EVALUATION AND CLINICAL
DECISION MAKING
◉ 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.
