Hypo/hyperthyriodism

The clinic nurse is taking vital signs on a client who reports being fatigued every day and gaining weight lately despite not eating much.  The nurse should also ask about which symptoms?

Select all that apply.

1.  Cold intolerance

2.  Constipation

3.  Fever

4.  Menstrual irregularity

5.  Night sweats

6.  Tachycardia

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Fatigue and weight gain are classic manifestations of hypothyroidism.  Features of hypothyroidism typically result from decreased metabolic rate and include cold intolerance, constipation, dry skin, irregular or prolonged menstrual periods, and mental slowing or difficulty concentrating.

(Options 3, 5, and 6)  Fever, tachycardia, and sweating are signs of hyperthyroidism, which is a hypermetabolic state, with signs and symptoms that are usually the opposite of those seen in hypothyroidism.  The presenting symptoms of a hyperthyroid client would likely include weight loss despite an increased appetite and difficulty sleeping.

Educational objective:

Hypothyroidism is associated with symptoms of a low metabolic rate; hyperthyroidism causes symptoms of a high metabolic rate.

A middle-aged man comes into the clinic for a check-up. His pulse is 49 beats per minute and the client reports that he has gained 20 pounds in the past two months. The nurse also notices that his skin is cool to touch and that he has three layers of clothing. The nurse suspects hypothyroidism. Which nursing diagnosis should be of the highest priority?

A. Fatigue

B. Activity intolerance

C. Hypothermia

D. Decreased cardiac output

EXPLANATION

Choice D is correct. Cardiac output is essential to ensure adequate blood flow to all parts of the body. It is affected by the circulating blood volume and heart rate. If left unattended, a decreased pulse can lead to shock. It should take priority over all other nursing diagnoses.

Choice B is incorrect. The client may experience activity intolerance due to hormonal changes in hypothyroidism, but this is not a priority nursing diagnosis.

Choice A is incorrect. The client may experience fatigue due to hormonal changes in hypothyroidism, but this is not a priority nursing diagnosis.

Choice C is incorrect. Due to decreased metabolism, clients with hypothyroidism have reduced tolerance to cold. This, however, should not be prioritized over the problem of decreased cardiac output.

The nurse is caring for a client taking levothyroxine (Synthroid)

for hypothyroidism.

Which finding indicates a side effect of this

medication?

A. weight loss

B. weight gain

C. light sensitivity

D. excessive sleepiness

Rationale: A side effect of levothyroxine is weight loss. Weight gain

and light sensitivity are not side effects of this medication.

Levothyroxine can cause insomnia, not excessive sleepiness

A nurse is developing a plan of care for a client who has myxedema coma. Which of the following actions should the nurse include? (Select all that apply.)

A. Monitor the client for cardiac dysrhythmias.

B. Observe the client for evidence of urinary tract infection.

C. Initiate Intravenous (IV) fluids using 0.9% sodium chloride for the client.

D. Administer a levothyroxine IV bolus to the client.

E. Provide the client with cooling blankets to prevent hyperthermia.

Correct Answers: 

A. Monitor the client for cardiac dysrhythmias.

B. Observe the client for evidence of urinary tract infection.

C. Initiate Intravenous (IV) fluids using 0.9% sodium chloride for the client.

D. Administer a levothyroxine IV bolus to the client.

A client who has myxedema can have a flat or inverted T wave as well as ST deviations. An infection, such as a urinary tract infection, can precipitate myxedema coma. The nurse should observe the client for manifestations of infection so that the underlying illness can be treated. Hyponatremia is an expected finding in the presence of myxedema coma. The nurse should administer IV therapy using 0.9% sodium chloride. Myxedema coma is a severe complication of hypothyroidism that, if left untreated, can lead to coma or death. The nurse should administer a levothyroxine IV bolus to treat the condition.

A client with Graves’ disease is brought to the ER with a

suspected thyroid storm. The nurse expects to see what signs

and symptoms?

A. seizures, jaundice, irregular heartbeat, vomiting

B. bradycardia, septic shock, polyuria

C. increased cranial pressure, thready pulse, rash across

chest

D. poor muscle tone, dyspnea, cyanosis

Option A

Rationale: A thyroid storm is a life-threatening complication of

hyperthyroidism seen in clients with Graves’ disease. Signs and

symptoms may include seizures, jaundice, irregular heartbeat, and

vomiting. Agitation, dehydration, and heart failure may also be seen.

The other answer groups are not specific to Graves’ disease.

Which of the following are symptoms of Grave’s disease or hyperthyroidism? (Select all that apply.)

A. Weight gain

B. Myxedema coma

C. Palpitations

D. Bradycardia

E. Protruding eyeballs

Correct Answers:

C. Palpitations

E. Protruding eyeballs

Grave's disease, which accounts for 75% of hyperthyroid disease, is caused by production of antibodies to the TSH receptors in the thyroid gland. These antibodies stimulate the TSH receptors, causing the thyroid gland to overproduce and release excessive amounts of thyroid hormones T3 and T4.

🔹Hyperthyroidism causes palpitations, heat intolerance, weight loss without a change in appetite, anxiety, insomnia, and increased perspiration. Hypertension, hyperreflexia, tremor, atrial fibrillation, proximal muscle weakness, exophthalmos, and lid lag may be noted on physical examination. The release of T3 and T4 hormones results in a suppressed level of serum thyroid stimulating hormone (TSH). In Grave's disease, antibodies to the receptors for TSH continue to stimulate the receptors on the thyroid gland.

The eye findings of hyperthyroidism include irreversible protrusion of eyeballs and lid lag, which refers to delayed movement of the eyelid when the eye looks down. The eye findings result from the expansion of retro-orbital tissues and weakness of eye muscle fibers.

Incorrect Answers:

A. Weight gain is associated with hypothyroidism, which is caused by a deficiency of thyroid hormone. It causes a reduced metabolic rate.

B. Myxedema coma is a complication of hypothyroidism.

D. Bradycardia is associated with hypothyroidism.

Vital Concept:

Grave's disease is an autoimmune disorder and the most common cause of hyperthyroidism. Radioactive iodine uptake testing is used to differentiate Grave's disease from other forms of hyperthyroidism. Treatments block the adverse effects of excess thyroid hormone and prevent release of thyroid hormone by the thyroid gland. They include antithyroid medications, radioactive iodine treatment, and surgical subtotal thyroidectomy.

.A nurse is reviewing serum laboratory data for four male clients. Which client would require the most immediate assessment?

A: Thyroid-stimulating hormone [TSH] 12 mU/L [normal: 2-10 mU/L]

B: Free T4 [Thyroxine] 7.0 ng/dL [normal: 0.8-2.8 ng/dL]

C: Growth hormone 8 ng/mL [normal: 0-6 ng/mL]

D: Glucose 130 mg/dL [normal: 70-110 mg/dL]

1. Client A

2. Client B

3. Client C

4. Client D

2. Correct: An excess of thyroid hormone is the most life-threatening of the findings listed due to its effects on the cardiovascular system of hypertension and tachycardia. The client should be assessed for impending thyroid storm.

1. Incorrect: An elevated TSH level occurs in hypothyroidism. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones which are essential for life. Not life-threatening.

3. Incorrect: An elevated growth hormone produces acromegaly with resulting bone and soft tissue deformities and enlarged viscera. But this is not life threatening.

4. Incorrect: Though the glucose level is elevated, a level of 130 mg/dL (7.2 mmol/L) does not require immediate assessment or intervention.

The nurse prepares teaching material for a client prescribed levothyroxine. Which information does the nurse include when instructing the client? (Select all that apply.)

1. "Take the medication for a full 10 days, even if you feel better."

2. "Call your health care provider if you feel your heart is racing."

3. "You should have more energy once the medication has reached a therapeutic level."

4. "Ensure you have an adequate supply of medication when going on vacation."

5. "Take the medication with food, just before going to bed."

6. "Ask your health care provider before taking over-the-counter cold remedies."

1) INCORRECT - Levothyroxine must be taken for life and not just for 10 days. This statement would be included if the client is prescribed an antibiotic.

2) CORRECT — Feeling like the heart is racing may indicate that the dose is too high. Heart racing is an adverse effect of the medication.

3) CORRECT — This medication is used to treat hypothyroidism, which causes a loss of energy and feelings of lethargy. Taking the medication as prescribed should decrease these feelings.

4) CORRECT — The medication needs to be taken every day, so an adequate supply needs to be available.

5) INCORRECT - The medication should be taken in the morning on an empty stomach.

6) CORRECT — Some over-the-counter medications may interfere with levothyroxine. All over-the-counter medications should be approved by the health care provider before the client takes them.

The nurse is caring for a client ten weeks pregnant with hyperthyroidism.

Which of the following treatment options would be appropriate for this client?

Select one:

Methimazole

Propylthiouracil

Radioactive iodine

Surgical removal

RATIONALE:

Correct Answer:

(Option #2): Propylthiouracil is a medication used to treat hyperthyroidism. This medication is the drug of choice in the 1st trimester due to rare safety concerns regarding its teratogenic effects. After the first trimester, propylthiouracil is typically contraindicated fo the remainder of pregnancy and during breastfeeding due to the risk of hepatotoxicity.

Incorrect Answers:

(Option #1): Methimazole is contraindicated in the 1st trimester due to malformations risk due to organogenesis.

(Option #3): Radioactive iodine is contraindicated throughout the entire pregnancy and during breastfeeding due to its teratogenic effects.

(Option #4): The surgical removal of the thyroid gland is a relative contraindication due to the surgery itself. In the first trimester, anesthetics used for the surgery are teratogenic. This treatment option would not be appropriate for this client.

The nurse is caring for a client diagnosed with a myxedema coma. The nurse should anticipate a prescription for which of the following medications?

  Select all that apply.

A. Levothyroxine

B. Methimazole

C. Tolvaptan

D. Vasopressin

E. Hydrocortisone

✅ A. Levothyroxine

✅ E. Hydrocortisone

Rationale:

• Levothyroxine: Myxedema coma is a severe form of hypothyroidism, so thyroid hormone replacement with levothyroxine (T4) is essential.

• Hydrocortisone: Given empirically because adrenal insufficiency may coexist and thyroid hormone replacement can increase cortisol requirements. Steroids are generally given before or alongside levothyroxine until adrenal insufficiency is ruled out.

B. Methimazole: Used to treat hyperthyroidism, not hypothyroidism.

C. Tolvaptan: A vasopressin receptor antagonist used for certain cases of hyponatremia and other conditions, not standard treatment for myxedema coma.

D. Vasopressin: Used for conditions such as vasodilatory shock or diabetes insipidus, not routine treatment for myxedema coma.