Thyroid

Question 1

What hormone controls production and release of thyroid hormones?

Answer 1

Thyroid-stimulating hormone (TSH)

Question 2

A child is diagnosed with hypothyroidism. The nurse anticipates an order for the drug of choice when treating children, which is what?

Answer 2

Levothyroxine (Synthroid)

Question 3

The nurse is providing patient teaching regarding the administration of levothyroxine (Synthroid). What is the nurses priority teaching point?

Answer 3

• Take the medication with a full glass of water
• The medication should be taken on an empty stomach before breakfast

Question 4

Methimazole (Tapazole) is used to treat:

Answer 4

hyperthyroidism

Question 5

Important lab monitoring for Methimazole:

Answer 5

Regular labs to monitor for bone marrow suppression, which can be an adverse effect

Question 6

What assessment findings would the nurse expect to see in a patient who overdosed on levothyroxine (Synthroid)?

Answer 6

Nervousness, tachycardia, tremors

Question 7

After administering propylthiouracil (PTU), what effect would the nurse anticipate the drug will have in the patients body?

Answer 7

To inhibit production of thyroid hormone in the thyroid gland

Question 8

In patients taking levothyroxine; what lab results would indicate a need for drug increase?

Answer 8

Elevated TSH, reduced T3 and T4 levels: TSH levels would be elevated to stimulate increased thyroid hormone secretion whereas T4 and T3 will be low

Question 9

The nurse is caring for a patient newly diagnosed with hypothyroidism. The patient also takes theophylline to control asthma symptoms. What changes will need to be made to the patients theophylline dose?

Answer 9

Increase theophylline dosage immediately:

Rationale: Theophylline clearance is decreased in hypothyroid states. As the patient approaches normal thyroid function, theophylline dose may need to be adjusted frequently

Question 10

The patient is 8 weeks pregnant and requires an antithyroid medication. The nurse identifies what drug as the drug of choice for this patient?

Answer 10

Propylthiouracil (PTU) because it is less likely to cross the placenta and cause problems for the fetus

Question 11

What signs/symptoms should the provider educate a patient who’s taking thyroid supplementation:

Answer 11

• Increased pulse rate; teach how to measure pulse (if greater than 100bpm at rest- dose should be withheld)
• nervousness
• chest pain,
• HTN
• unexplained weight loss of more than 2 pounds in 1 week

Question 12

Drug interactions with thyroid replacements:

Answer 12

• Avoid concurrent use of TCA’s
• Calcium and iron supplements should be taken 2 to 4 hours before or after the hormone

Question 13

If a dose of a thyroid replacement (synthroid) is missed, the patient should:

Answer 13

Take the dose as soon as it is remembered, if 4 hours after eating. If more than three doses are missed, the health-care provider should be informed.

Question 14

If a patient changes brand of thyroid supplement medications, the provider should:

Answer 14

Monitor the patient’s TSH levels and titrate new drug over several months; advise patient NOT to change brands

Question 15

Contraindications for the use of thyroid replacements:

Answer 15

Recent MI; they increase risk of cardiovascular events

Question 16

True or false

Thyroid replacements can be used with women that have osteoporis

Answer 16

True, BUT provider should use lowest dose possible as thyroid replacements may exacerbate bone loss

Question 17

ADR’s for thyroid replacement drugs:

Answer 17

• increased heart rate
• cardiac arrhythmias
• chest pain
• tremors/nervousness
• insomnia
• weight loss
• menstrual irregularities
• heat intolerance

Question 18

What are the two drugs used for hyperthyroidism?

Answer 18

Propylthiouracil & Methimazole

Question 19

How do hyperthyroidism drugs work? (MOA)

Answer 19

inhibit the synthesis of thyroid hormones

Question 20

Propylthiouracil (PTU) is primarly metabolized by:

Answer 20

the liver with a significant first-pass effect

Question 21

Out of the two hyperthyroid drugs, which one should be used first line-in pregnancy?

Answer 21

propylthiouracil; Methimazole is associated with birth defects

Question 22

True or False

Both hyperthyroidism drugs cross the placenta during pregnancy

Answer 22

True. They both cross the placenta and can induce goiter and even cretinism in the fetus.

Question 23

What is the most serious adverse reaction when using hyperthyroid drugs?

Answer 23

agranulocytosis and possible aplastic anemia

Question 24

Blackbox warning for propylthiouracil:

Answer 24

Liver failure can occur; it should be reserved for those patients for whom surgery or methimazole is not appropriate

Question 25

Drug interactions with propylthiouracil:

Answer 25

• lithium, potassium iodide, or sodium iodide: Additive antithyroid effects
• warfarin

Question 26

Drug interactions with methimazole:

Answer 26

• Potassium iodide & amiodarone: decrease antithyroid effects

Question 27

Drug interactions with both hyperthyroid drugs:

Answer 27

• Any drug that produces bone marrow depression causes additive bone marrow depression
• phenothiazines: increased risk of agranulocytosis

Question 28

TSH levels should be evalutated:

Answer 28

Before beginning therapy, whenever symptoms recur, whenever dosages are adjusted, and every 2 to 3 months throughout therapy

Question 29

What symptoms should patient be taught when reporting signs of agranulocytois:

Answer 29

sore throat, fever, chills, rash, and unusual bleeding or bruising

Question 30

After starting methimazole it may take up to _ to _ months to see a total reversal of hyperthyroid symptoms:

Answer 30

6-12 months

Question 31

A woman who is pregnant and has hyperthyroidism is best managed by a specialty team who will most likely treat her with:

Answer 31

Propylthiouracil (PTU)

Question 32

6. When starting a patient on levothyroxine for hypothyroidism the patient will need follow-up measurement of thyroid function in:

Answer 32

4 weeks

Question 33

Treatment of a patient with hypothyroidism and cardiovascular disease consists of:

Answer 33

Levothyroxine

Question 34

When starting a patient with hypothyroidism on thyroid replacement hormones patient education would include:

Answer 34

It may take 4 to 8 weeks to get to euthyroid symptomatically and by laboratory
testing.

Question 35

In hyperthyroid states, what organ system other than CV must be evaluated to establish potential adverse issues?

Answer 35

The eye

Question 36

What happens to the typical hormone replacement dose when a woman becomes pregnant?

Answer 36

The average woman needs more medication during pregnancy.