NR 565 Final Study Guide
WEEK 5
...
Thyroid
o Diagnosis & Evaluation
What labs are used to diagnose?
-TSH - used primarily for screening and diagnosing hypothyroid and for monitoring replacement therapy in hypothyroid
patients
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for thyroid dysfunction
-T3 - Useful in the diagnosis of hyperthyroidism; can also be used to monitor hormone replacement therapy
-TSH low
-T4 normal
-T3 is high = hyperthyroidism
,Thyroid
o Diagnosis & Evaluation
Timeframe for re-check of labs after starting levothyroxine?
Recheck TSH 6-8 weeks after initiating therapy and after any dosage change; Check TSH at least once a year after
serum TSH is stabilized
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hypothyroidism?
Hypothyroidism: Depend on severity.
o Mild: subtle and may go unrecognized
o Moderate to severe:
-Face is pale, puffy, and expressionless.
-Skin cold and dry.
-Hair is brittle and hair loss occurs.
,-Slowed Heart rate.
-Patient may complain of lethargy, fatigue, and
-Temperature is lowered & intolerant to cold.
-Thyroid Enlargement may occur if reduced levels of T3
and T4
Mentation may be impaired.
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hyperthyroidism?
o Elevated Heart rate and strong, and dysrhythmias and angina may develop
o The CNS is stimulated, resulting is nervousness, insomnia, rapid thought flow, and rapid speech, hyperreflexia, tremors
o Skeletal muscles may weaken and atrophy
o Metabolic rate is raised, resulting in health and skin that is warm and moist
o Feeling Hot + Heat intolerance
o Appetit is increased but fails to match metabolic rate resulting in weight loss
o All of these signs are referred to as thyrotoxicosis
o Also usually present with exophthalmos - bulging of the eyes
, Thyroid
o Treatment
Treatment of thyroid storm?
Characterized by profound hyperthermia (105 degrees F or higher), severe tachycardia, restlessness, agitation, and
tremor.
Unconsciousness, coma, hypotension, and heart failure may ensure.
These symptoms are produced by excessive levels of thyroid hormone
Thyroid crisis can be life threatening and requires immediate treatment.
o High doses of potassium iodide or strong iodine solution are given to suppress thyroid hormone release.
o Methimazole is given to suppress thyroid hormone synthesis
o A beta blocker is given to reduce heart rate
o Additional measures include sedation, cooling, and giving
glucocorticoids and IVF
Thyroid
o Treatment
Result of not treating hypothyroidism during pregnancy?
Can result in permanent neuropsychological deficits in the child - decrease child's IQ
The effect of hypothyroidism is limited largely to the first trimester, a time during which the fetus is unable to produce
thyroid hormone of its own
Some authorities currently recommend routine screening for hypothyroidism as soon as pregnancy is confirmed
WEEK 5
...
Thyroid
o Diagnosis & Evaluation
What labs are used to diagnose?
-TSH - used primarily for screening and diagnosing hypothyroid and for monitoring replacement therapy in hypothyroid
patients
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for thyroid dysfunction
-T3 - Useful in the diagnosis of hyperthyroidism; can also be used to monitor hormone replacement therapy
-TSH low
-T4 normal
-T3 is high = hyperthyroidism
,Thyroid
o Diagnosis & Evaluation
Timeframe for re-check of labs after starting levothyroxine?
Recheck TSH 6-8 weeks after initiating therapy and after any dosage change; Check TSH at least once a year after
serum TSH is stabilized
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hypothyroidism?
Hypothyroidism: Depend on severity.
o Mild: subtle and may go unrecognized
o Moderate to severe:
-Face is pale, puffy, and expressionless.
-Skin cold and dry.
-Hair is brittle and hair loss occurs.
,-Slowed Heart rate.
-Patient may complain of lethargy, fatigue, and
-Temperature is lowered & intolerant to cold.
-Thyroid Enlargement may occur if reduced levels of T3
and T4
Mentation may be impaired.
Thyroid
o Diagnosis & Evaluation
Signs and symptoms of hyperthyroidism?
o Elevated Heart rate and strong, and dysrhythmias and angina may develop
o The CNS is stimulated, resulting is nervousness, insomnia, rapid thought flow, and rapid speech, hyperreflexia, tremors
o Skeletal muscles may weaken and atrophy
o Metabolic rate is raised, resulting in health and skin that is warm and moist
o Feeling Hot + Heat intolerance
o Appetit is increased but fails to match metabolic rate resulting in weight loss
o All of these signs are referred to as thyrotoxicosis
o Also usually present with exophthalmos - bulging of the eyes
, Thyroid
o Treatment
Treatment of thyroid storm?
Characterized by profound hyperthermia (105 degrees F or higher), severe tachycardia, restlessness, agitation, and
tremor.
Unconsciousness, coma, hypotension, and heart failure may ensure.
These symptoms are produced by excessive levels of thyroid hormone
Thyroid crisis can be life threatening and requires immediate treatment.
o High doses of potassium iodide or strong iodine solution are given to suppress thyroid hormone release.
o Methimazole is given to suppress thyroid hormone synthesis
o A beta blocker is given to reduce heart rate
o Additional measures include sedation, cooling, and giving
glucocorticoids and IVF
Thyroid
o Treatment
Result of not treating hypothyroidism during pregnancy?
Can result in permanent neuropsychological deficits in the child - decrease child's IQ
The effect of hypothyroidism is limited largely to the first trimester, a time during which the fetus is unable to produce
thyroid hormone of its own
Some authorities currently recommend routine screening for hypothyroidism as soon as pregnancy is confirmed
