NR565 week 5
1. Signs and symptoms of hypothyroidism and hyperthyroidism:
Hypothy- roidism:
Thick, coarse, dry Hyporeflexia, "hung up" patella reflex Slow thought
process, Weight gain (5-10 lbs./2.25-4.5 kg) Constipation,
Menorrhagia, Cold intolerance: Cold all the time
Hyperthyroidism (aka graves disease):
Smooth, silky Hyperreflexia, Mind racing, Weight loss (10 lbs./4.5 kg)
Diarrhea, loose, frequent stools, Oligomenorrhea, Heat intolerance:
Hot all the time
pg. 418-419
2. What adjunctive therapy is good to prescribe to control symptoms of
hyper- thyroidism other than thyroid specific medications?
Know drug classes and examples of those drug classes.: ²-Blockers and
nonra- dioactive iodine may be used as adjunctive therapy. ²-Blockers
suppress tachycardia by blocking ²-receptors on the heart. Nonradioactive
iodine inhibits synthesis and release of thyroid hormones.
pg. 419
3. Monitoring needs and intervals for thyroid medications.: levothyroxine-
Mon- itoring: 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.
Methimazole-Monitoring: Check CBC with differential if signs or symptom
of infec- tion. Check LFTs if signs or symptoms of liver dysfunction.
Propylthiouracil (PTU)- Treatment continues for 1-2 years
PTU has caused rare cases of liver injury. Onset is sudden and
progression is rapid.
4. - Propylthiouracil (PTU) carries a risk for liver toxicity. Although rare, the
FDA recommends against using PTU as a first-line treatment due to
potential for hepatic toxicity.: Treatment continues for 1-2 years
PTU has caused rare cases of liver injury. Onset is sudden and
progression is rapid. pg 421
5. - Effects of maternal hypothyroidism on offspring and appropriate
patient teaching related to need for treatment.: Maternal hypothyroidism
can result in permanent neuropsychological deficits in the child.
, NR565 week 5
can decrease IQ and other aspects of neuropsychological function in
the child. teaching:
,to help ensure healthy fetal development, maternal hypothyroidism
must be diag- nosed and treated very early.
some authorities currently recommend routine screening for
hypothyroidism as soon as pregnancy is confirmed. If hypothyroidism is
diagnosed, replacement therapy should begin immediately.
the signs and symptoms of pregnancy mimics those of hypothyroidism
When women taking thyroid supplements become pregnant, dosage
requirements usually increase—often by as much as 50%. The need for
increased dosage begins between weeks 4 and 8 of gestation, levels off
at approximately week 16, and then remains steady until parturition.
pg. 418
6. - Patient teaching for thyroid medications.: :levothyroxine:
should be taken on an empty stomach in the morning, at least 30 to
60 minutes before breakfast.
Inform patients about the symptoms of thyrotoxicosis and instruct them
to notify the prescriber if these develop (Sweating, irritability, weight los
tachycardia)Instruct patients to separate administration of levothyroxine
and these drugs by 4 hours
Overdose may cause thyrotoxicosis. Symptoms include tachycardia,
angina, tremor, nervousness, insomnia, sweating, and heat intolerance.
methamizole:
Agranulocytosis: Inform patients about early signs of agranulocytosis,
including fever or sore throat. If follow-up blood tests reveal leukopenia,
methimazole should be stopped.
Hypothyroidism: Methimazole may cause excessive reductions in
thyroid hormone synthesis. If signs of hypothyroidism develop or if
plasma levels of T3 and T4 become subnormal, dosage should be
reduced.
Radioactive Iodine:
Inform patients about symptoms of iodism, including brassy taste,
burning sensa- tions in the mouth, and soreness of gums and teeth.
, Iodine can also cause corrosive injury to the GI tract. Instruct patients to
notify the prescriber if severe abdominal distress develops.
1. Signs and symptoms of hypothyroidism and hyperthyroidism:
Hypothy- roidism:
Thick, coarse, dry Hyporeflexia, "hung up" patella reflex Slow thought
process, Weight gain (5-10 lbs./2.25-4.5 kg) Constipation,
Menorrhagia, Cold intolerance: Cold all the time
Hyperthyroidism (aka graves disease):
Smooth, silky Hyperreflexia, Mind racing, Weight loss (10 lbs./4.5 kg)
Diarrhea, loose, frequent stools, Oligomenorrhea, Heat intolerance:
Hot all the time
pg. 418-419
2. What adjunctive therapy is good to prescribe to control symptoms of
hyper- thyroidism other than thyroid specific medications?
Know drug classes and examples of those drug classes.: ²-Blockers and
nonra- dioactive iodine may be used as adjunctive therapy. ²-Blockers
suppress tachycardia by blocking ²-receptors on the heart. Nonradioactive
iodine inhibits synthesis and release of thyroid hormones.
pg. 419
3. Monitoring needs and intervals for thyroid medications.: levothyroxine-
Mon- itoring: 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.
Methimazole-Monitoring: Check CBC with differential if signs or symptom
of infec- tion. Check LFTs if signs or symptoms of liver dysfunction.
Propylthiouracil (PTU)- Treatment continues for 1-2 years
PTU has caused rare cases of liver injury. Onset is sudden and
progression is rapid.
4. - Propylthiouracil (PTU) carries a risk for liver toxicity. Although rare, the
FDA recommends against using PTU as a first-line treatment due to
potential for hepatic toxicity.: Treatment continues for 1-2 years
PTU has caused rare cases of liver injury. Onset is sudden and
progression is rapid. pg 421
5. - Effects of maternal hypothyroidism on offspring and appropriate
patient teaching related to need for treatment.: Maternal hypothyroidism
can result in permanent neuropsychological deficits in the child.
, NR565 week 5
can decrease IQ and other aspects of neuropsychological function in
the child. teaching:
,to help ensure healthy fetal development, maternal hypothyroidism
must be diag- nosed and treated very early.
some authorities currently recommend routine screening for
hypothyroidism as soon as pregnancy is confirmed. If hypothyroidism is
diagnosed, replacement therapy should begin immediately.
the signs and symptoms of pregnancy mimics those of hypothyroidism
When women taking thyroid supplements become pregnant, dosage
requirements usually increase—often by as much as 50%. The need for
increased dosage begins between weeks 4 and 8 of gestation, levels off
at approximately week 16, and then remains steady until parturition.
pg. 418
6. - Patient teaching for thyroid medications.: :levothyroxine:
should be taken on an empty stomach in the morning, at least 30 to
60 minutes before breakfast.
Inform patients about the symptoms of thyrotoxicosis and instruct them
to notify the prescriber if these develop (Sweating, irritability, weight los
tachycardia)Instruct patients to separate administration of levothyroxine
and these drugs by 4 hours
Overdose may cause thyrotoxicosis. Symptoms include tachycardia,
angina, tremor, nervousness, insomnia, sweating, and heat intolerance.
methamizole:
Agranulocytosis: Inform patients about early signs of agranulocytosis,
including fever or sore throat. If follow-up blood tests reveal leukopenia,
methimazole should be stopped.
Hypothyroidism: Methimazole may cause excessive reductions in
thyroid hormone synthesis. If signs of hypothyroidism develop or if
plasma levels of T3 and T4 become subnormal, dosage should be
reduced.
Radioactive Iodine:
Inform patients about symptoms of iodism, including brassy taste,
burning sensa- tions in the mouth, and soreness of gums and teeth.
, Iodine can also cause corrosive injury to the GI tract. Instruct patients to
notify the prescriber if severe abdominal distress develops.
