Endocrine - Thyroid Disorders

Question 1

Hypothyroidism

aka myxedema coma

Answer 1

-low T3 + T4
“everything down except weight”
wt gain, slow metab, low energy, low temp, etc

more common than hyperthyroid

Question 2

Hyperthyroidism

aka thyroid storm

Answer 2

“everything up except weight”
wt loss, high metab, high energy, high temp, INSOMNIA, incr hrt rt, HTN, seizures, dysrhythmias, tremors
-exophthalmos, grave’s disease

harder to treat than hypothyroid

Question 3

euthyroid

Answer 3

normally functioning thyroid

Question 4

common problem with medicating hypothyroid meds?

Answer 4

underdosage - hypo
overdosage - hyper

-takes a while to achieve homeostasis

Question 5

treatment for

hypo vs hyperthyroidism

Answer 5

hypo - hormone replacement

hyper - hormone antagonist

• ——— destruction of thyroid
• ——— surgery to remove

Question 6

levothyroxine

Answer 6

levo has 4 letters > T4

Question 7

levothyroxine

MOA

Answer 7

hormone replacement

Question 8

levothyroxine

CI

Answer 8

• following an MI
• caution w angina
• CAD
• Tx of obesity

Question 9

levothyroxine

indication

Answer 9

• lab values

- may have goiter

Question 10

*levothyroxine

A/E

Answer 10

HYPERhyroid s/s

INSOMNIA, incr HR, HTN, seizures, dysrhythmias, tremors, nervous, wt loss, diaphoresis, headache, irritability

Question 11

levothyroxine

Interactions

Answer 11

• incr anticoag effect (warfarin)

- incr insulin req

Question 12

*levothyroxine

admin

Answer 12

PO pill
**30-60 mins in AM b4 breakfast
(first thing in AM to prevent insomnia)

• can crush mix w water
• don’t take w Soy Isoflavones

Question 13

*levothyroxine

RN/teaching

Answer 13

• full effect/PEAK takes 4-8wks
• DO NOT stop abruptly
• HOLD if HR>110
• dose gradually incr

Question 14

treatment options for hyperthyroid

Answer 14

1 medical therapy

2 surgical therapy

Question 15

surgical therapy for hyperthyroidism

Answer 15

• unresponsive to drug therapy
• large goiters/tumor causing tracheal compression
• malignancy
• emergency

Question 16

medical therapy options for hyperthyroidism

Answer 16

1 thionamides (anti thyroid drugs)
2 I-131 (radioactive iodine therapy)
3 B-adrenergic blockers (adjunt meds)
4 Lugol’s Soln (iodine)

Question 17

treatment of choice in NON-PREGNANT adults w hyperthyroidism

Answer 17

Radioactive I-131 “Iodotope”

• postTx, usually hypo - will need lifelong replacement
• requires radiation precautions

Question 18

Radioactive I-131
“Iodotope”
MOA

Answer 18

-uptaken by thyroid cells>

damages/destroys thyroid tissue

Question 19

*Radioactive I-131
“Iodotope”
CI

Answer 19

• category X
• no young children
• no breastfeeding
• shellfish/sulfite allergy

Question 20

Radioactive I-131
“Iodotope”
indication

Answer 20

• thyroid cancer

- med non-responders

Question 21

Radioactive I-131
“Iodotope”
A/E

Answer 21

• sore throat
• bone marrow depression (pancytopenia)
• radiation sickness (hematemesis, epistaxis,, N/V)
• HYPO
• dysgeusia

Question 22

Radioactive I-131
“Iodotope”
interactions

Answer 22

w lugol’s soln + iodine soln

Question 23

*Radioactive I-131
“Iodotope”
admin

Answer 23

• client secretion will be radioactive until Iodine decays
• TDS (time, distance, shielding)
• drink LOTS of water after admin

Question 24

*Radioactive I-131
“Iodotope”
RN/teaching

Answer 24

• 6 ft distance
• isolate/limit contact to 30 min/day
• don’t prep food, share utensils
• incr fluid intake
• careful disposal

Question 25

methimazole, PTU

Answer 25

class: thionamides

Question 26

methimazole, PTU | MOA

Answer 26

- blocks synth of thryoid hormones | - -blocks T3 fr converting to T4

Question 27

methimazole, PTU | CI

Answer 27

- lactation/breastfeeding | - other Iodine products

Question 28

*methimazole, PTU | Indication

Answer 28

- Euthyroid state before/after surgery - before surgery, PTU given + B blocker - usually given when levo was unsuccessful

Question 29

*methimazole, PTU | A/E

Answer 29

HYPO s/s -drowsy, deprssn, wt gain, edema, bradycrda, cold intolerance, low BP, pancytopenia/agranulocytosis PTU is hepatoxic

Question 30

methimazole, PTU | interactions

Answer 30

anticoag

Question 31

methimazole, PTU | admin

Answer 31

w/meals | -consistent time each day

Question 32

methimazole, PTU | RN/teaching

Answer 32

- monitor wt - careful w female - full effect/peak 3-12 wks - avoid consumption of shellfish + high iodine food

Question 33

*when administrating methimazole or PTU, always monitor for ____

Answer 33

Brady, sore throat, fever

Question 34

Lugol's Soln | MOA

Answer 34

inhibits synt of T3 + T4 | ----for short term treatment only

Question 35

Lugol's Soln | RN/teaching

Answer 35

can stain teeth - sip w straw - PC meals (prevent GI upset) - assess moral mucosa for irritation