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Levothyroxine is used to treat hypothyroidism.
Thyrotoxicosis, hyperthyroidism (from excessive doses).
Monitor thyroid function and indications of hyperthyroidism, such as anxiety and tachycardia.
Early in the morning
PO on Empty stomach, at least 30 to 60 minutes before breakfast.
Baseline vital signs, weight, and height, with periodic monitoring thereafter.
Patients should report nervousness, rapid heart rate, palpitations, tremors, altered appetite, heat intolerance, fever, sweating, weight loss, and chest pain.
Thyrotoxicosis and recent myocardial infarction.
Cholestyramine, antacids, iron and calcium supplements, and sucralfate.
Always take on Empty stomach to enhance absorption and effectiveness.
Expect lifelong replacement therapy.
What is the therapeutic use of propylthiouracil (PTU) ?
Hyperthyroidism,
Thyrotoxic crisis (thyroid storm)
Suppress thyroid hormone production in preparation for thyroidectomy.
Agranulocytosis (a severe drop in white blood cells) and
Liver toxicity.
Hypothyroidism may also occur as a result of treatment.
Rash (very common)
Aplastic anemia (a rare but serious condition in which the bone marrow fails to produce enough new blood cells, including red blood cells, white blood cells, and platelets)
Vertigo, drowsiness, headaches
Propylthiouracil should be taken orally Q8H - due to short-half life.
Monitor for manifestations of both hyperthyroidism and hypothyroidism.
CBC (agranulocytosis and liver toxicity)
Pregnant women (teratogenic effects can occur), periodic CBC monitoring
Liver toxicity
Infections due to immunosuppression
Bone marrow depression.
What interaction occurs with anticoagulants and levothyroxine?
Anticoagulant effects of warfarin may increase.
Patients should report fever, sore throat, rash, joint or muscle pain, headache, and any OTC medications or supplements.
Therapeutic use of radioactive iodine?
Grave’s disease (hyperthyroidism)
Thyroid cancer (longer duration of Tx)
What are common side-effects of radioactive iodine?
Hypothyroidism (expected for most patients)
Bone marrow depression (rare) - can lead to agranulocytosis.
Radiation sickness (rare)
What are some nursing interventions for patients taking radioactive iodine?
Monitor for s/s of hypothyroidism (weight gain, edema, anorexia, cold intolerance, dry skin, drowsiness)
Monitor for signs of radiation sickness
Monitor for agranulocytosis
What are some contraindications of radioactive iodine?
Pregnancy (teratogenic effects)
Lactation (excretion in breast milk)
What are some interactions of radioactive iodine?
Iodine-131 uptake may be reduced when taken with other antithyroid medications.
What are some isolation measures patient taking radioactive iodine need to take to prevent others from getting radiation sickness?
Isolation for at least 1-2 weeks
Avoid close contact with others, especially pregnant women and children.
Use separate bathrooms if possible and flush toilet 3x times since medication is excreted through the urine.
Washing eating utensils, clothes, and linens separately
Using toilet not used by others for 2 weeks.
What are some signs and symptoms of radiation sickness in patient taking radioactive iodine?
Bloody vomit (hemoptysis)
Nosebleeds, or severe N/V
What are some special instructions a nurse must give for female patients that are about to begin a treatment of thyroid cancer with radioactive iodine?
Confirm a negative pregnancy test prior to therapy and
tell the client to use effective contraception throughout treatment.
How long before thyroid cancer patients can expect to see the full effect of the treatment?
2 to 3 months before the full effect of iodine-131 can be expected.
Some common symptoms of hyperthyroidism include:
Weakness, easy fatiguability, exercise intolerance.
Rationale: While hyperthyroidism increases the metabolic rate, it can paradoxically lead to muscle weakness, fatigue, and exercise intolerance. This is because the excessive thyroid hormones cause a hypermetabolic state that depletes energy stores and nutrients faster than they can be replenished. The muscles cannot get enough fuel to function optimally despite the increased metabolic demands.:
What are some unique clinical presentations to hyperthyroidism?
Grave’s disease (exopthalmos)
Pretibial myxedema: a dry waxy swelling of the lower tibia that resembles skin lesions.
A nurse is reviewing the chart of a client with Graves' disease. Which laboratory result should the nurse expect?
a) Decreased thyroid-stimulating hormone (TSH)
b) Increased TSH
c) Decreased free thyroxine (T4)
d) Decreased triiodothyronine (T3)
Decreased TSH
Rationale: In Graves' disease, excessive thyroid hormones suppress the release of TSH from the anterior pituitary through a negative feedback mechanism.
Which of the following is the most common cause of hyperthyroidism?
a) Toxic adenoma
b) Thyroiditis
c) Graves' disease
d) Exogenous hyperthyroidism
Graves' disease is the most common cause of hyperthyroidism
Rationale: Graves' disease is an autoimmune disorder that results in excessive thyroid hormone production and is the leading cause of hyperthyroidism.
A nurse is assessing a client with Graves' disease who has developed exophthalmos. Where should the nurse expect to observe this condition?
Over the right or left eye
Rationale: Exophthalmos is the protrusion of the eyeballs due to edema and fat accumulation behind the eyes, a hallmark of Graves' disease.
A client with hyperthyroidism reports nervousness, increased sweating, and weight loss. These symptoms are related to which physiological effect?
Increased metabolic rate
Rationale: Hyperthyroidism leads to an excessive metabolic rate, resulting in symptoms like nervousness, increased sweating, and weight loss.
Which medication is used to block the effects of increased thyroid hormones but does not alter hormone levels?
Propranolol (beta blockers is commonly used for symptom control of the heart rate and tremors in patients with hyperthyroidism)
Rationale: Propranolol is a beta-blocker that manages symptoms like tachycardia and palpitations but does not affect thyroid hormone production.
A nurse is caring for a client who is taking methimazole for hyperthyroidism. Which lab value should be monitored regularly? (Select all that apply.)
Complete blood count (CBC)
Triiodothyronine (T3)
White blood cell (WBC) count
Rationale: Methimazole can cause leukopenia, so CBC and WBC counts should be monitored. T3/T4 levels should also be monitored to assess treatment effectiveness.
A client with hyperthyroidism is prescribed radioactive iodine therapy. Which of the following precautions should be taken post-treatment? (Select all that apply.)
Flush the toilet three times after use
Avoid contact with pregnant individuals for the first week (at least 1 meter away from pregnant women)
Limit contact to no more than 1 hr/day.
Take a laxative 2-3 days after Tx to rid the body of stool contaminated w/ radiation
Effect of Tx might take 6 to 8 weeks
Rationale: Radioactive iodine therapy emits radiation, requiring precautions like avoiding contact with pregnant individuals, using separate personal items, and flushing the toilet multiple times.
Which of the following is an expected finding in an older adult with hyperthyroidism?
Atrial fibrillation
Rationale: In older adults, hyperthyroidism may present as a single symptom such as atrial fibrillation, rather than the typical symptoms seen in younger individuals.
A nurse is providing care for a client post-thyroidectomy. Which items should be readily available at the bedside? (Select all that apply.)
Suction equipment
Humidified oxygen
Tracheostomy tray
Rationale: Post-thyroidectomy clients are at risk for airway obstruction. Suction equipment, humidified oxygen, and a tracheostomy tray should be available.
Which of the following findings is indicative of thyroid crisis? (Select all that apply.)
b) Hyperthermia, d) Chest pain, e) Tachydysrhythmias Rationale: Thyroid storm is characterized by hyperthermia, chest pain, and tachydysrhythmias. Hypotension and bradycardia are not associated with thyroid crisis.
A client undergoing thyroidectomy reports tingling in the mouth and hands. The nurse recognizes this as a sign of:
Hypocalcemia
Rationale: Damage to the parathyroid glands during surgery can cause hypocalcemia, leading to tingling and muscle spasms. Without PTH, the parathyroid gland cannot increase calcium levels when needed.
A nurse is teaching a client about taking iodine solutions. Which statement indicates a need for further teaching?
"I will take this medication on an empty stomach."
Rationale: Iodine solutions should be taken with food or liquid to prevent gastric irritation.
A nurse is providing instructions to a client taking propranolol for hyperthyroidism. Which statement should be included?
"Check your pulse before each dose."
Rationale: Propranolol (beta blocker, ends in -lol) can cause bradycardia, so the pulse should be monitored before taking the medication.
Which dietary recommendation should be included for a client with hyperthyroidism?
High-protein, high-carbohydrate diet
Otherwise, the patient may experience weakness, fatigue.
Rationale: Clients with hyperthyroidism have an increased metabolic rate and require a high-protein, high-carbohydrate diet to meet energy demands.
Which intervention should the nurse include to minimize the client’s energy expenditure in hyperthyroidism?
Provide assistance with activities as needed and schedule rest periods.
Rationale: Clients with hyperthyroidism experience increased metabolism, which can lead to fatigue. Assisting with activities and promoting rest helps conserve energy.
What is an appropriate nursing intervention to promote eye protection for a client with exophthalmos?
Provide lubricating eye drops and tape the eyelids closed at night if necessary.
Rationale: Exophthalmos can lead to corneal dryness and damage. Lubricating eye drops and taping the eyelids closed at night help protect the eyes.
Which intervention should the nurse prioritize for a client with Graves' disease experiencing restlessness and irritability?
Reduce room stimuli and provide a calm environment.
Rationale: Clients with hyperthyroidism are sensitive to excessive stimulation. A calm environment helps reduce restlessness and irritability.
What finding requires immediate intervention in a client who is 24 hours post-thyroidectomy?
Positive Chvostek’s sign (signs of hypocalcemia)
Rationale: A positive Chvostek’s sign indicates hypocalcemia, which may occur if the parathyroid glands were damaged during surgery. This requires immediate intervention to prevent complications like tetany.
What preoperative intervention should the nurse implement for a client preparing for a thyroidectomy?
Administer propylthiouracil (PTU) or methimazole as prescribed.
Rationale: Antithyroid medications are given preoperatively to achieve a euthyroid state and reduce the risk of thyroid storm during surgery.
Which item should the nurse ensure is at the client’s bedside after a total thyroidectomy?
Tracheostomy tray.
Rationale: Airway obstruction is a potential complication due to post-surgical swelling or bleeding. A tracheostomy tray should be readily available in case of emergency airway compromise.
Which assessment finding indicates possible airway obstruction in a client who is 12 hours post-thyroidectomy?
Stridor and restlessness.
Rationale: Stridor and restlessness indicate airway obstruction, a medical emergency requiring immediate intervention.
What is the first intervention the nurse should implement for a client experiencing a thyroid storm?
Provide supplemental oxygen.
Rationale: Airway and oxygenation are always the priority in a thyroid storm. Providing supplemental oxygen helps meet the increased metabolic demand.
Which statement by the client indicates understanding of dietary needs for hyperthyroidism?
'I need to eat more high-protein and high-carbohydrate foods.'
Rationale: Clients with hyperthyroidism have an increased metabolic rate and require a high-calorie, high-protein, and high-carbohydrate diet to prevent excessive weight loss.
Which statement by a client post-thyroidectomy indicates the need for further teaching regarding signs of hypocalcemia?
'I will report heart palpitations and chest pain.'
Rationale: While palpitations and chest pain can be related to hyperthyroidism, they are not specific indicators of hypocalcemia. Hypocalcemia is characterized by tingling, muscle spasms, and a positive Chvostek’s sign (facial twitching when the cheek is tapped).
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