Week 14: Endocrine- Thyroid Flashcards
What does low TSH mean?
What does high TSH mean?
Hyperthyroidism
Hypothyroidism
Drugs to TREAT Hypothyroidism?
How long does the treatment last?
Levothyroxine (GOLD STANDARD) = Synthetic T4
Liothyronine= Synthetic T3
Patients are on therapy for LIFE!!
Levothyroxine (T4) is used to treat?
What happens if you take too much?
Symptoms of Levothyroxine overdose?
HEART
Boxed warning for?
All forms of hypothyroidism
Myxedema Coma
Overdose- Hyperthyroidism
Heat intolerance
Excitement (insomnia)
Angina / Afib
Restless
Tachycardia/Tremor
DO NOT use as treatment for obesity/weight loss
Levothyroxine (T4) Administration?
Start with?
Check what and hold if?
This drug requires?
Give when?
Dont change?
Start with a low dose and increase based on TSH + symptoms
Check a pulse before giving (hold if >100)
This drug requires an empty stomach (acidic pH)
DO NOT give with supplements, milk, yogurt
Give first thing in the morning
Hospitals typically give around 0600
Don’t change MANUFACTURERS
Levothyroxine (T4) Drug interactions
Do not give with?
How long does it take to work
Do not give with bile acid sequestrants (cholestyramine) separate by 4 hours
4-6 weeks after starting
HYPERthyroidism is caused by?
Hyperthyroidism symptoms?
HEART
-Graves disease
-Thyroid storm (induced by stress or infection)
*Severe and potentially life threatening
Heat intolerance
Excitement (insomnia)
Angina / Afib
Restless
Tachycardia/Tremor
Methimazole + Propylthiouracil (PTU)
Can be used to treat? 3
Hyperthyroidism
Graves Disease
Thyroid Storm
(give w/ Propranolol-why?) for heart
Methimazole + PTU adverse effect?
PTU boxed warning for?
Both cause?
Liver and Bone Marrow Suppression
PTU- BOXED WARNING- hepatotoxicity!!!!
BOTH cause: agranulocytosis and hepatotoxicity (bone marrow & liver toxicity)
agranulocytosis: low WBC
Methimazole + PTU
NURSING CONSIDERATIONS:
Avoid eating?
Monitor for?
How does it manifest?
How does leukopenia manifest?
Avoid eating foods high in iodine (seafood, soy sauce, tofu, and iodized salt)
Liver & Bone Marrow Suppression:
Manifested as fever, sore throat, lesions
What is thyroid storm?
Induced by?
give what for heart?
and what else?
Extreme surge of thyroid hormone (T3 +T4)
Induced by Stress or Infection
EXTREMELY DANGEROUS
Give Propranolol
Give PTU (or maybe Methimazole)
What works fast for thyroid storm?
What takes weeks to work?
PTU works FAST for Thyroid Storm (ACUTE)
PTU + Methimazole take several weeks to manage CHRONIC hyperthyroidism
Radioactive Iodine does what?
Potassium iodide (SSKI) does what?
Destroys thyroid gland
Patient will need thyroid replacement therapy for the rest of their life.
Prevent absorption of radioactive iodine
