NURS 5338 Final Exam Review Questions with
Verified Correct Answers
hypothyroidism
hashimoto's
insufficient thyroid hormones (T3 + T4)
primary hypothyroid - elevated TSH, low T4, low T3
subclinical hypothyroid - elevated TSH, normal T4 & T3
congenital hypothyroidism - present at birth
Causes - can be caused by meds like amiodarone or lithium, by iodine deficiency, iatrogenic
(thyroidectomy or radioactive iodine)
S/S -- Think "everything slows down"
Fatigue, weight gain
Cold intolerance
Constipation
Depression
Dry skin, hair loss
Bradycardia
Menstrual irregularities
Dry, coarse skin
Periorbital edema
S/S in babies: lethargy, poor feeding, hypotonia, jaundice, hoarse cry, macroglossia, coarse
face hairs, constipation, umbilical hernia
,Hypothyroid treatment
Levothyroxine - healthy adults <60 - 1.6mcg/kg/day
Elderly/Comorbidities - 12.5-25mcg/kg/day
TSH determines levothyroxine dosage
subclinical - treat if TSH >10
Adjust dose q4-6 weeks, once stable every 6-12 months
Pregnancy - increase levothyroxine dose by 30%
Synthroid - synthetic treatment containing T4
Armour Thyroid (Desiccated) - unpredictable, derived from pig, less stable, contains T3+T4
Take first thing in the morning on an empty stomach
Avoid taking with calcium or iron supplements
Myxedema Coma
Emergency!
Severe hypothyroidism
AMS, hypothermia, bradycardia
Hyperthyroidism
excess T3 and T4
Primary hyperthyroid - low TSH, elevated T3/T4
S/S: goiter, exophthalmos, pretibial myxedema, heat intolerance, weight loss, tremors,
tachycardia, palpitations, tachycardia, fatigue, tremor, depression, light periods,
hyperreflexia, insomnia, anxiety
,clonus: abnormal reflex movements of the foot by sudden dorsiflexion causing contraction
and relaxation
Hyperthyroidism Treatment
1st line: methimazole - inhibits thyroid hormone synthesis
Pregnancy - use PTU in first trimester
Other options:
- Beta blocker to manage tachycardia
- Radioactive iodine - treatment of graves
- Surgery to remove goiter, nodules, malignancy
Addison's Disease
Primary Adrenal Insufficiency - damage to the adrenal gland decreases cortisol and
aldosterone
Primary - caused by autoimmune, TB, HIV, CMV, fungal, tumors, congenital adrenal
hyperplasia, hemorrhage
Secondary - caused by pituitary dysfunction leading to decreased ACH and adrenal atrophy,
can be from chronic steroid use with abrupt withdrawal
S/S: fatigue, weight loss, hypotension, salt craving, hyperpigmentation
Addisonian Crisis
, life threatening cortisol deficiency
triggered by stress, illness, steroid withdrawal
s/s: hypotension, shock, hyponatremia, hyperkalemia
Tx: IV hydrocortisone, fluids, correct electrolytes, give glucose
Cushing's Syndrome
chronic cortisol excess
Tx: gradual taper of steroids
Cushing's Disease
pituitary adenoma causing increased ACTH leading to increased cortisol
s/s: moon face, buffalo hump, central obesity, HTN, hyperglycemia, muscle weakness, purple
striae, skin thinning, easy bruising, poor wound healing
Untreated can cause osteoporosis, infections, severe hypertension
Dx:
1st line tests - 24 hour urinary free cortisol and low dose dexamethasone suppression test
Tx: transsphenoidal surgery (remove adenoma)
Hyperparathyroidism
Verified Correct Answers
hypothyroidism
hashimoto's
insufficient thyroid hormones (T3 + T4)
primary hypothyroid - elevated TSH, low T4, low T3
subclinical hypothyroid - elevated TSH, normal T4 & T3
congenital hypothyroidism - present at birth
Causes - can be caused by meds like amiodarone or lithium, by iodine deficiency, iatrogenic
(thyroidectomy or radioactive iodine)
S/S -- Think "everything slows down"
Fatigue, weight gain
Cold intolerance
Constipation
Depression
Dry skin, hair loss
Bradycardia
Menstrual irregularities
Dry, coarse skin
Periorbital edema
S/S in babies: lethargy, poor feeding, hypotonia, jaundice, hoarse cry, macroglossia, coarse
face hairs, constipation, umbilical hernia
,Hypothyroid treatment
Levothyroxine - healthy adults <60 - 1.6mcg/kg/day
Elderly/Comorbidities - 12.5-25mcg/kg/day
TSH determines levothyroxine dosage
subclinical - treat if TSH >10
Adjust dose q4-6 weeks, once stable every 6-12 months
Pregnancy - increase levothyroxine dose by 30%
Synthroid - synthetic treatment containing T4
Armour Thyroid (Desiccated) - unpredictable, derived from pig, less stable, contains T3+T4
Take first thing in the morning on an empty stomach
Avoid taking with calcium or iron supplements
Myxedema Coma
Emergency!
Severe hypothyroidism
AMS, hypothermia, bradycardia
Hyperthyroidism
excess T3 and T4
Primary hyperthyroid - low TSH, elevated T3/T4
S/S: goiter, exophthalmos, pretibial myxedema, heat intolerance, weight loss, tremors,
tachycardia, palpitations, tachycardia, fatigue, tremor, depression, light periods,
hyperreflexia, insomnia, anxiety
,clonus: abnormal reflex movements of the foot by sudden dorsiflexion causing contraction
and relaxation
Hyperthyroidism Treatment
1st line: methimazole - inhibits thyroid hormone synthesis
Pregnancy - use PTU in first trimester
Other options:
- Beta blocker to manage tachycardia
- Radioactive iodine - treatment of graves
- Surgery to remove goiter, nodules, malignancy
Addison's Disease
Primary Adrenal Insufficiency - damage to the adrenal gland decreases cortisol and
aldosterone
Primary - caused by autoimmune, TB, HIV, CMV, fungal, tumors, congenital adrenal
hyperplasia, hemorrhage
Secondary - caused by pituitary dysfunction leading to decreased ACH and adrenal atrophy,
can be from chronic steroid use with abrupt withdrawal
S/S: fatigue, weight loss, hypotension, salt craving, hyperpigmentation
Addisonian Crisis
, life threatening cortisol deficiency
triggered by stress, illness, steroid withdrawal
s/s: hypotension, shock, hyponatremia, hyperkalemia
Tx: IV hydrocortisone, fluids, correct electrolytes, give glucose
Cushing's Syndrome
chronic cortisol excess
Tx: gradual taper of steroids
Cushing's Disease
pituitary adenoma causing increased ACTH leading to increased cortisol
s/s: moon face, buffalo hump, central obesity, HTN, hyperglycemia, muscle weakness, purple
striae, skin thinning, easy bruising, poor wound healing
Untreated can cause osteoporosis, infections, severe hypertension
Dx:
1st line tests - 24 hour urinary free cortisol and low dose dexamethasone suppression test
Tx: transsphenoidal surgery (remove adenoma)
Hyperparathyroidism
