Thyroid

2.Which medication(s) to treat hyperthyroidism and the associated symptoms should the nurse include in the teaching plan for a client who is newly diagnosed with hyperthyroidism? Select all that apply. A. Propylthiouracil B. Methimazole C. Prednisolone D. Propranolol E. Fluconazole

All except E.Pharmacological treatment options to treat hyperthyroidism include anti-thyroid drugs, such as methimazole or propylthiouracil; beta-blockers to treat symptoms such as elevated blood pressure; and radioactive iodine. Other treatment options include surgery to remove the thyroid or symptom management.

8.A nurse is caring for a client admitted for complications related to hyperthyroidism. Which task is most appropriate to delegate to the assistive personnel (AP)? A. Administering intravenous amiodarone B. Notifying the provider if the client's heart rate is above 140/min C. Interpreting laboratory results D. Obtaining daily weights each morning

An interdisciplinary plan of care for clients with hyperthyroidism should include decreasing stimulation, monitoring vital signs and blood work results, and monitoring for signs of fluid retention (swelling, weight gain). When working with an interdisciplinary team, it is important for the nurse to understand each team member's role in the care of clients. The nurse should only delegate activities or tasks to the assistive personnel (AP) using the five rights of delegation: right task, right circumstance, right person, right supervision, and right direction and communication.

The nurse is caring for a client with Graves disease that has not been treated. Which finding will most likely be discovered by the nurse on assessment? A. Pruritus B. Body mass index (BMI) of 35 C. Constipation D. Fatigue

Assessment findings for clients with Graves disease hyperthyroidism include enlarged thyroid (goiter), weight loss, exophthalmos, warm and/or moist skin, tremors, tachycardia and other cardiac arrhythmias. Fatigue may be associated with hyperthyroidism due to increased activity and insomnia.

5.The nurse in a primary care office is counseling a client with Graves disease who is experiencing exophthalmos. Which activity(ies) should the nurse teach the client to avoid? Select all that apply. A. Wearing sunglasses outside B. Standing in front of air-conditioners or fans C. Prolonged use of contact lenses D. Prolonged periods of reading E. Keeping the environment humid

Clients with hyperthyroidism at risk for exophthalmos should be advised to avoid mild risk factors, such as prolonged reading, excessive computer screen engagement, prolonged contact lens use, brisk air-conditioning flow, reduced humidity as on commercial flights, and direct exposure to chemicals as in exhaled tobacco.

1.A female client with hyperthyroidism has a triiodothyronine (T3) level of 415ng/dL and a thyroxine (T4) level of 21.0μg/dL. Which symptom(s) of hyperthyroidism should the nurse expect this client to demonstrate? Select all that apply. A. Goiter B. Exophthalmos C.Bradycardia D.anxiety E.diarrhea F.Amenorrhea

Clients with hyperthyroidism may exhibit weight loss, diarrhea, heat intolerance, diaphoresis, hyperactivity, tachycardia, and palpitations. Some clients with hyperthyroidism may present with a neck mass due to an enlarged thyroid, known as goiter. In females, hyperthyroidism can cause menstrual cycle irregularities, while in males, it can cause erectile dysfunction and gynecomastia, or breast enlargement. Clients with Graves disease may exhibit Graves' ophthalmopathy, which can manifest as exophthalmos, which is anterior bulging of the eyes, as well as chemosis, which is swelling and redness of the conjunctiva. Graves disease can also cause pretibial myxedema, where the skin of the shin becomes swollen, red, and hard.

14.Which assessment finding(s) for a client with hypothyroidism should the nurse, working at an institution that uses charting by exception (CBE), document in detail? Select all that apply. A. Poor dentition B. Weight gain of five pounds in two months C. Skin is pink, dry and warm D. Periorbital non-pitting edema E. Client states, "I can't seem to get warm lately."

Completing accurate documentation on clients experiencing hypothyroidism is important to ensure healthcare team communication and continuity of care. Charting by exception (CBE) is a shorthand method of documenting normal findings, where significant abnormal findings or exceptions to the predefined norms are documented in detail. Abnormal findings supporting the diagnosis of hypothyroidism include weight gain, periorbital non-pitting edema, and cold intolerance.

A client with a history of hyperthyroidism arrives at the emergency department by ambulance with altered mental status. The nurse obtains the following vital signs: Temperature 39.6℃ (103.2℉) Pulse of 187/min Respirations 30/minute Blood pressure 196/101 mmHg Which assessment question is most appropriate to ask the client during the initial assessment? A. "Are you compliant with your antihypertensive medication?" B. "Do you have a history of panic attacks?" C. "Have you been recently diagnosed with an infection?" D. "When was your last bowel movement?

Complications of hyperthyroidism include development of arrhythmias, like atrial fibrillation; osteoporosis or bone fractures due to interference with calcium absorption; vision problems or vision loss; edema; or thyroid storm (also called thyrotoxic crisis). Thyroid storm is a life-threatening condition that is associated with untreated or undertreated hyperthyroidism. During a thyroid storm, an individual's heart rate, blood pressure, and body temperature can soar to dangerously high levels. Because thyroid storms are often fatal without prompt, aggressive treatment, it is important that the nurse recognize signs and symptoms of this condition.

7.The nurse is caring for a client with primary hypothyroidism. Which laboratory result(s) help(s) to support this diagnosis? Select all that apply. A. Sodium 131 mEq/L B. Free thyroxine (T4) 3.5 ng/dL C. Cholesterol level 150 mg/dL D. Thyroid stimulating hormone (TSH) 6.5 mIU/L E. Free triiodothyronine (T3) 0.9 pg/mL

Diagnosis of hypothyroidism is usually based on history and clinical findings, and can be confirmed via blood tests by measuring the levels of triiodothyronine (T3) and thyroxine (T4), which will be low, as well as thyroid stimulating hormone (TSH), which will be high in the case of primary hyperthyroidism. In the case of secondary and tertiary hyperthyroidism, TSH will most often be low. Clients diagnosed with hypothyroidism will have elevated cholesterol due to the decreased lipid metabolism. In addition, clients will have decreased sodium levels due to decreased water excretion from elevated antidiuretic hormone levels.

6.A nurse is caring for a 21-year-old female client with a history of type 1 diabetes mellitus and atopic dermatitis. Her current body mass index (BMI) is 23. Which non-modifiable risk factors for hyperthyroidism does this client have? Select all that apply. A.Age B.Female gender C.BMI DType1 DM E.Steroid use

Hyperthyroidism can be classified as primary or secondary. In primary hyperthyroidism, the problem is an overactive thyroid gland, like in thyroiditis. For thyroiditis, risk factors include viral upper respiratory tract infection and pregnancy, which increases the risk for postpartum thyroiditis. Other risk factors for thyroiditis include certain medications, like amiodarone or lithium, as well as radiation therapy for cancers in the neck region. In secondary hyperthyroidism, an underlying problem, such as Graves disease, leads to an overactive thyroid. For Graves disease, risk factors include female sex, having a family history of Graves disease, and having another autoimmune disorder like type 1 diabetes mellitus or primary adrenal insufficiency

5.The nurse is educating the student nurse about hypothyroidism. The student nurse states, "I know hypothyroidism is when the thyroid gland produces low amounts of thyroid hormones, but how should the thyroid normally function?" In which order should the nurse explain how a normal thyroid functions? Arrange the statements in order from first to last. All options must be used. A.Protein synthesis is stimulated and energy is burned in the form of sugars and fats. B.Thyroxine (T4) gets converted to triiodothyronine (T3). C.The cells in the body absorb triiodothyronine (T3) and thyroxine (T4). D.Thyrotropin-releasing hormone (TRH) stimulates the anterior pituitary gland to release thyroid-stimulating hormone (TSH), stimulating hormone production by the thyroid gland. E.The thyroid gland releases triiodothyronine (T3) and thyroxine (T4) into the bloodstream. F.The hypothalamus detects low blood levels of thyroid hormones and it releases thyrotropin-releasing hormone (TRH).

Hypothyroidism is a condition in which the thyroid gland produces and releases low amounts of thyroid hormones. Normal hormonal production is regulated by the hypothalamus, which is located at the base of the brain. When the hypothalamus detects low blood levels of thyroid hormones, it releases thyrotropin-releasing hormone (TRH). TRH then stimulates the anterior pituitary gland to release thyroid-stimulating hormone (TSH) which, in turn, stimulates hormone production by the thyroid gland, a butterfly-shaped gland located in the neck. The thyroid gland is made up of thousands of thyroid follicles, which release two iodine-containing thyroid hormones, triiodothyronine, or T3, and thyroxine, or T4, into the bloodstream. These hormones then get picked up by nearly every cell in the body. Once inside the cell, T4 is mostly converted into T3, which is the active form. T3 speeds up the cell's basal metabolic rate by stimulating protein synthesis, and burning up more energy in the form of sugars and fats. Other effects of thyroid hormones include increasing the cardiac output, stimulating bone resorption, as well as heat production and activating the sympathetic nervous system, which is responsible for the 'fight-or-flight' response.

3.A client with Graves disease was prescribed methimazole 12 weeks ago. The lab values at that time showed a triiodothyronine (T3) level of 415ng/dL, thyroxine (T4) level of 21.0μg/dL, and a thyroid-stimulating hormone (TSH) level <0.5 mIU/L. Baseline vital signs: Temperature 37.3℃ (99.1℉) Heart Rate 112/min Respirations 21/minute Blood pressure 165/93 mmHg Which lab result(s) and vital sign(s) at today's visit indicate effective treatment? Select all that apply. A. Decreased triiodothyronine (T3) level B. Blood pressure 210/101mmHg C. Pulse of 95/min D. Increased thyroid-stimulating hormone (TSH) level E. Decreased thyroxine (T4) level

Indicators for effective treatment of hyperthyroidism include thyroid-stimulating hormone (TSH), triiodothyronine (T3) and thyroxine (T4) levels returning to normal ranges; symptoms resolving; and no signs of complications, like thyroid storm (thyrotoxicosis).

The nurse is reviewing the electronic health record (EHR) of a client with Graves disease. Which nursing assessment documentation is most likely to correspond to a client with Graves disease? A. Sudden inability to urinate B. Dry, flaky skin on the face C. Swelling in the anterior neck D. Generalized muscle crampin

The electronic health record (EHR) helps the healthcare team to communicate and to monitor for changes in client condition. Assessment documentation for clients with hyperthyroidism should accurately reflect any present associated signs and symptoms of this condition. Common symptoms include goiter, moist skin, diaphoresis, abnormal vital signs (tachycardia and hypertension), and altered mood or activity level.

Which metabolic effect(s) result(s) from an increase in triiodothyronine (T3) and thyroxine (T4) levels in the body? Select all that apply. A. Decreasing heart rate B. Activating the sympathetic nervous system C. Decreasing cardiac output D. Increasing body temperature E. Stimulating bone reabsorption

The thyroid gland is made up of thousands of thyroid follicles, which release two iodine-containing thyroid hormones, triiodothyronine (T3) and thyroxine (T4), into the bloodstream. T3 speeds up the cell's basal metabolic rate by stimulating protein synthesis and burning up more energy in the form of sugars and fats. Other effects of thyroid hormones include increasing the cardiac output; stimulating bone resorption as well as heat production; and activating the sympathetic nervous system, which is responsible for our 'fight-or-flight' response. Clients with hyperthyroidism produce increased levels of these hormones and experience a hypermetabolic state.

3.The nurse is creating an educational plan for a client diagnosed with anemia secondary to hypothyroidism. The nurse plans to teach the client about iron-rich foods. Which food(s) should the nurse include? Select all that apply. A.Liverwurst B.Spinach C.Tofu D.Sardines E.Legumes F. Dried apricots

A complication of hypothyroidism is anemia. Clients diagnosed with hypothyroidism may have low levels of triiodothyronine (T3) and thyroxine (T4) production which can lead to decreased erythropoiesis, also known as red blood cell formation. Decreased red blood cell production leads to anemia. Clients with anemia secondary to hypothyroidism should be educated on consuming iron-rich foods such as tofu, sardines, dried apricots, legumes, and spinach.

12.The nurse is providing education to a client diagnosed with primary hypothyroidism resulting from Hashimoto's disease, who has developed a goiter. Which statement by the client indicates further education is necessary? A. "This goiter resulted from my own immune system attacking my thyroid." B. "I plan on increasing the amount of iodine I eat every day to shrink my goiter." C. "If I take my levothyroxine, the size of my goiter will decrease over time." D. "I should contact my doctor if I feel short of breath or have trouble swallowing."

A goiter is an expected finding associated with diagnosis of hypothyroidism in clients diagnosed with Hashimoto's disease, which is an autoimmune disorder. Hashimoto's damages the thyroid gland so that it produces too little of thyroid hormones triiodothyronine (T3) and thyroxine (T4) . Sensing a low hormone level, the pituitary gland produces more thyroid stimulating hormone (TSH) to stimulate the thyroid, which then causes the gland to enlarge, resulting in a goiter. Clients diagnosed with a goiter should contact the healthcare team if respiratory distress or trouble swallowing develops and take thyroid replacement hormones as prescribed.

Which results of an iodine reuptake test correlates with a diagnosis of Graves hyperthyroidism A. Decreased uptake of radioactive iodine B. Absence of radioactive iodine uptake C. Localized uptake of radioactive iodine D. Diffuse and generalized radioactive iodine uptake

A radioactive iodine uptake test can be used to diagnose thyroid abnormalities. For example, in Graves disease, the scan will show a diffuse and generalized uptake of radioactive iodine across the thyroid gland. Toxic nodular goiter and adenoma presents with a localized uptake, and thyroiditis results in decreased thyroid uptake of radioactive iodine as the gland's follicles are actually destroyed

7.The nurse is planning to educate a group of clients who have been newly diagnosed with hyperthyroidism. Which statement(s) should the nurse include about the cause(s) of hyperthyroidism? Select all that apply. A. "Graves disease is an autoimmune cause of hyperthyroidism." B. "Hyperthyroidism can develop related to thyroid cancer." C. "Pituitary dysfunction can cause hyperthyroidism." D. "Treatment for hypothyroidism can cause hyperthyroidism. E. "Elevated calcium can contribute to hyperthyroidism." F. "Hyperthyroidism can be classified as primary or secondary."

All not E,Common causes of hyperthyroidism include primary causes, such as in Graves disease, multinodular goiter, thyroiditis, and cancer, and secondary causes, such as pituitary dysfunction or intake of exogenous thyroid hormones.

6.The nurse is preparing a client suspected of having hypothyroidism for a radioactive iodine uptake test. The client asks the nurse, "What is going to happen during this test?" Which is the best response by the nurse? A. "You will swallow radioactive iodine capsules and, after several hours, a probe will measure the amount of radioactivity in your thyroid gland." B. "The doctor will inject your immune antibodies with radioactive iodine to measure what percentage they will absorb." C. "This is an ultrasound study where the doctor will measure the width and length of the thyroid gland using radioactive lightwaves." D. "During this test, you will have blood work drawn to analyze the amount of triiodothyronine (T3) and thyroxine (T4) released by the thyroid."

Diagnosis of hyperthyroidism is usually based on history and clinical findings, and can be confirmed via blood tests. The blood tests measure the levels of triiodothyronine (T3) and thyroxine (T4), which will be low, as well as thyroid stimulating hormone (TSH), which will be high in the case of primary hyperthyroidism. In secondary and tertiary hyperthyroidism, TSH will most often be low. Other diagnostic blood tests include a complete blood count to check for anemia, lipid profile to look for hypercholesterolemia, and serum electrolytes, which commonly show hyponatremia. For Hashimoto's thyroiditis, antibody testing can be done. In addition, a radioactive iodine uptake test can be performed. A radioactive iodine uptake test measures how much radioactive iodine is taken up by the thyroid gland in a given time period. Clients are asked to ingest radioactive iodine in liquid or capsule form. After a time, usually between 6 and 24 hours later, they must return to have the radioactivity measured. Next, a gamma probe is placed over the thyroid gland in the neck to measure the amount of radioactivity in the thyroid gland. This amount of radioactivity is compared with the original dose of radioactivity and reported as a percent of the original dose. Decreased uptake indicates a diagnosis of hypothyroidism.

2.The nurse is caring for several clients diagnosed with hypothyroidism. Which client's assessment data is most consistent with tertiary hypothyroidism? A. A young adult client who sustained head trauma during a motor vehicle accident B. A neonate born without a thyroid gland due to a genetic mutation C. An adult client from India who has a goiter on the right side of the neck D. An elderly female client who was diagnosed with an anterior pituitary gland tumor

Hypothyroidism occurs when there are low levels of thyroid hormones, which causes a slowing down of metabolic processes. Hypothyroidism is usually either primary, secondary, or tertiary. In primary hypothyroidism, the problem is an underactive thyroid gland. The most common cause of primary hypothyroidism is nutritional iodine deficiency, especially in countries that do not fortify food with iodine. On the other hand, the most common cause of primary hypothyroidism in countries that fortify foods with iodine is Hashimoto thyroiditis, which is an autoimmune disorder against the thyroid gland, ultimately destroying it. Another cause of primary hypothyroidism is thyroiditis, which is an inflammation of the thyroid gland. This may initially cause the release of thyroid hormones resulting in hyperthyroidism. Later on, hormones will be depleted and the gland can no longer keep pace with the damage, which results in hypothyroidism. Finally, primary hypothyroidism can be congenital, also called cretinism, which affects a newborn's central nervous system development. Most of the time it is sporadic, but it can also be caused by an inherited genetic mutation. Ultimately, the newborn's thyroid gland may be absent, underdeveloped, or unable to make enough thyroid hormones. On the other hand, secondary hypothyroidism is usually due to an anterior pituitary gland tumor or infarction, which may prevent thyroid stimulating hormone (TSH) production. Finally, tertiary hypothyroidism occurs when there is damage to the hypothalamus due to trauma or compression, leading to decreased thyroid releasing hormone (TRH) production.

11.The student nurse is caring for a client diagnosed with myxedema coma resulting from long-term hypothyroidism. The student says to the nurse preceptor, "There are so many things to do for this client, what is my priority action?" Which nursing intervention should the nurse preceptor tell the student nurse to perform first? A. Place the client in high Fowler's position B. Administer prescribed oral levothyroxine C. Cover the client in a warming blanket D. Administer prescribed intravenous (IV) fluids

If not treated, hypothyroidism can result in a serious complication called myxedema coma. This is a medical emergency where the body goes into a state of severe and profound slowing of metabolic processes, leading to cardiovascular collapse. This is usually triggered by acute stress like surgery, infection, and trauma, and presents with hypothermia, hypotension, metabolic abnormalities like hypoglycemia and lactic acidosis, as well as worsening edema, seizures, impaired consciousness, and possibly coma. The nurse should prioritize maintaining airway patency prior to administering thyroid hormone replacement, intravenous (IV) therapy and warming the client.

4.The nurse on the surgical intensive care unit is caring for a client one day post-thyroidectomy. Which observation is most important to report to the provider? A. An intact surgical dressing B. Hoarse quality to the voice C. Temperature of 37.3C (99.1F) D. Infiltration of the peripheral IV with normal saline infusion

Important signs and symptoms to relay to the healthcare team in clients with hyperthyroidism include signs of electrolyte imbalance, microvascular or macrovascular complications (signs of stroke), changes in cognition, non-adherence to treatment, cardiac abnormalities, and changes in voice quality or volume.

13.A client diagnosed with hypothyroidism is being evaluated by the emergency department nurse. The client recently underwent a dental procedure and states, "Ever since my surgery, I haven't felt right." Which clinical manifestation is a possible sign of myxedema coma and should be reported to the healthcare provider immediately? A. Temperature 96°F (35.6°C) B. Blood glucose 90 mg/dL C. Respiratory rate 14/min D. Lactate dehydrogenase (LDH) 88 U/L

One serious complication of inadequately treated hypothyroidism is myxedema coma. This is a medical emergency where the body goes into a state of severe and profound slowing of metabolic processes, leading to cardiovascular collapse. This is usually triggered by acute stress such as surgery, infection, and trauma, and presents with hypothermia, hypotension, metabolic abnormalities like hypoglycemia and lactic acidosis, as well as worsening edema, seizures, impaired consciousness, and possibly coma. It is the nurse's responsibility to recognize symptoms of complications and report them to the healthcare provider immediately.

9.The nurse is collecting data from a female client who is suspected of having hypothyroidism. Which clinical manifestation(s) should the nurse expect to find? Select all that apply. A. Hot flashes B. Menorrhagia C. Vocal hoarseness D. Dry skin E. Diarrhea

Symptoms of hypothyroidism include modest weight gain despite a decreased appetite, as well as constipation due to decreased gastrointestinal motility. In addition, clients may experience cold sensitivity because the body is producing less heat. Hypothyroidism also causes bradycardia, fatigue, and shortness of breath. Often, clients may experience forgetfulness and decreased ability to concentrate, as well as paresthesia involving the limbs. Some clients with hypothyroidism may present with a neck mass due to an enlarged thyroid, known as a goiter. In addition, hypothyroidism leads to a buildup of glycosaminoglycans in the interstitium of many tissues, resulting in swelling in the skin and soft tissues like the tongue, as well as the vocal cords, which causes hoarseness. In the skin, the build up of glycosaminoglycans leads to water retention and eventually a non-pitting edema. Because of this, clients may have coarse and doughy skin, resulting in a puffy appearance with periorbital edema and dull facial expressions. In addition, because blood flow to the skin is decreased, the skin becomes cool and dry. Over time, hypothyroidism may result in coarse and brittle hair, which can lead to hair loss. In females, hypothyroidism can cause menstrual cycle irregularities, such as menorrhagia, in which menstrual bleeding is heavy or prolonged; or amenorrhea, where the menstrual cycle is absent. In males, hypothyroidism can cause decreased libido, erectile dysfunction, and delayed ejaculation.

10.The nurse is creating a plan of care for a client diagnosed with hypothyroidism experiencing a priority nursing diagnosis of Activity intolerance related to decreased metabolic processes. Which is the most appropriate client outcome statement? A. The client will perform active range of motion three times B. The client will ambulate more frequently by the end of the shift C. The client will verbalize less fatigue while bathing this morning D. The nurse will assist the client to the chair for breakfast by 0800

There are several nursing diagnoses that are applicable for clients diagnosed with hypothyroidism. Activity intolerance is an important diagnosis since clients who have hypothyroidism have slowed metabolic processes leading to extreme fatigue and inability to perform activities of daily living (ADLs). When creating an outcome statement, the nurse should ensure that it is specific, measurable, realistic, achievable and timely

8.The nurse is caring for an elderly female client with a familial history of hypothyroidism. The client asks the nurse, "What else puts me at risk for hypothyroidism?" Based on the client's electronic health record (EHR), which is the best response by the nurse A. "Taking the medication fluoxetine increases your likelihood of developing hypothyroidism since it blocks the absorption of serotonin, decreasing release of hormones from the hypothalamus." B. "Your history of radiation therapy in the neck region increases your risk of developing hypothyroidism since damage to the thyroid can occur during this treatment." C. "Your history of type 2 diabetes mellitus (DM) puts you at risk for hypothyroidism since this is an autoimmune disorder and so is hypothyroidism." D. "The amiodarone medicine you take increases the risk of hypothyroidism because it decreases myocardial workload, leading to less oxygenated blood flow to the thyroid gland."

There are some factors that increase the client's risk of developing hypothyroidism. For Hashimoto thyroiditis, risk factors include female sex, having a family history of Hashimoto thyroiditis, and having personal or family history for another autoimmune disorder like type 1 diabetes mellitus or celiac disease. For thyroiditis, risk factors include viral upper respiratory tract infection and pregnancy, which may lead to postpartum thyroiditis. Other risk factors for hypothyroidism include certain medications like amiodarone or lithium, as well as radiation therapy for cancers in the neck region. Finally, hypothyroidism can occur following treatment of hyperthyroidism, which may include surgical removal of the thyroid gland, use of radioactive iodine ablation, and the use of antithyroid medications like propylthiouracil and methimazole.

4.The nurse is performing discharge teaching for a client diagnosed with hypothyroidism after having a total thyroidectomy who was recently prescribed levothyroxine. Which instructions should the nurse provide the client? A. This medication will be discontinued once symptoms resolve. B. Take this medication along with an antacid to prevent nausea. C. Take this medication on an empty stomach first thing in the morning. D. Return to the doctor to have blood work done within six months.

Treatment for hypothyroidism includes thyroid hormone replacement therapy, primarily using levothyroxine, a synthetic version of thyroxine (T4). The dose of thyroxine should be adjusted so that levels of thyroid stimulating hormone (TSH) are in the lower-end or middle of the normal range within six to eight weeks after starting treatment. Clients should be instructed to take this medication on an empty stomach first thing in the morning before a meal and educated on the importance of taking this medication as prescribed for the rest of their lives. Levothyroxine should not be taken within four hours of antacids or iron supplements.

1.The nurse in the community health clinic is caring for a client diagnosed with hypothyroidism who was prescribed levothyroxine six weeks ago. Which client statement indicates that medication dosing may need to be decreased? A. "I've lost three pounds since starting this medication." B. "I don't think I need a stool softener anymore, I keep having diarrhea." C. "My skin looks pink and my tongue doesn't feel swollen." D. "I am feeling so sluggish and tired, I thought I'd feel better by now."

Treatment for hypothyroidism includes thyroid hormone replacement therapy, primarily using levothyroxine, a synthetic version of thyroxine (T4). The dose of thyroxine should be adjusted so that levels of thyroid stimulating hormone (TSH) are in the lower-end or middle of the normal range within six to eight weeks after starting treatment. If clients taking levothyroxine start to report symptoms of hyperthyroidism, such as diarrhea, it may indicate that the dose is too high. If clients report lingering symptoms of hypothyroidism, such as fatigue, it may indicate that the dose is too low.