Pharmacology: Chapter 36: Drugs Used to Treat Thyroid Disease

A postoperative total thyroidectomy patient is started on levothyroxine (Synthroid) daily. What information will the nurse include in discharge teaching? (Select all that apply.) a. "Close follow-up with your healthcare provider is important." b. "Notify your healthcare provider if you experience any palpitations or tachycardia." c. "A variation in emotions and personality is normal during this adjustment period." d. "Synthroid may be stopped as soon as the thyroid gland resumes functioning." e. "When energy levels have returned, Synthroid will be gradually tapered."

a. "Close follow-up with your healthcare provider is important." b. "Notify your healthcare provider if you experience any palpitations or tachycardia." c. "A variation in emotions and personality is normal during this adjustment period." Early intervention in correcting complications from the surgery or the hormone replacement therapy is crucial for a timely and positive outcome. Adverse effects such as tachycardia, anxiety, weight loss, abdominal cramping, and diarrhea are common but should be reported to the healthcare provider. After surgery, the goal is to return the patient to a euthyroid state with the use of replacement therapy. During this time of adjustment, patients will experience symptoms related to fluctuations in hormonal levels. Variation in emotions and personality may occur. The total thyroidectomy patient no longer has a thyroid gland and will not have hormone secretion. Synthroid is indicated for lifelong use in the patient who has had a total thyroidectomy.

A patient with myxedema complains to the nurse that he has a "hangover" the next morning after taking a pain medication at night. Which explanation by the nurse is the most accurate? a. "You have increased sensitivity to the medicine because of your thyroid condition." b. "Because you haven't been sleeping, you have increased fatigue and should increase the analgesic." c. "You are not taking enough thyroid medication and you should increase the dosage." d. "The pain medication is incompatible with your thyroid medication and you should find another analgesic to take."

a. "You have increased sensitivity to the medicine because of your thyroid condition." Myxedema patients are sensitive to small doses of sedative hypnotics, anesthetics, and narcotics. Increasing the analgesic would only make the patient feel more lethargic in the morning. The patient should not change the dose of his thyroid medication without consulting his primary healthcare provider. Any pain medication is likely to have this effect because of the patient's thyroid condition.

Which clinical manifestation(s) would the nurse assess in a patient with hypothyroidism? (Select all that apply.) a. Cold intolerance, weight gain b. Nervousness, agitation c. Increased susceptibility to infection d. Exophthalmos, fatigue e. Hypoactive reflexes

a. Cold intolerance, weight gain c. Increased susceptibility to infection e. Hypoactive reflexes Hypothyroid patients have a lower basal metabolic rate. This may be characterized by intolerance to cold, subnormal body temperature, weight gain, and slowness in motion, speech, and mental processes. Patients with hypothyroidism may become susceptible to infection. Nervousness and agitation are not manifestations of hypothyroidism. Exophthalmos and fatigue are not manifestations of hypothyroidism.

Which medication is used in the treatment of hypothyroidism? a. Levothyroxine (Synthroid) b. Radioactive iodine c. Propylthiouracil (Propacil) d. Methimazole (Tapazole)

a. Levothyroxine (Synthroid) Levothyroxine (T4) is one of the two primary hormones secreted by the thyroid gland. This hormone is partially metabolized to liothyronine (T3), so therapy with levothyroxine (Synthroid) replaces both hormones. Levothyroxine is considered the drug of choice for hormone replacement in hypothyroidism. Radioactive iodine, propylthiouracil, and methimazole are used to treat hyperthyroidism.

When assisting with the care of a patient with hyperthyroidism, the nurse will: a. provide a cool environment. b. anticipate ordering a low-calorie diet. c. limit daily caffeine intake. d. encourage intake of bran products.

a. provide a cool environment. For the hyperthyroid individual, the nurse should plan to provide a cool, quiet, structured environment because the patient lacks the ability to respond to change and anxiety-producing situations and has intolerance to heat. The individual with hyperthyroidism is usually ordered on a high-calorie diet of 4000 to 5000 calories/day with balanced nutrients. The individual with hyperthyroidism is to have no caffeine products. Because of the risk for diarrhea, bran products should not be encouraged.

A patient with a history of heart failure has been diagnosed with hypothyroidism. The drug interaction with glycosides and thyroid replacement therapy will most likely require which change in therapy? a. Decrease in the daily digoxin dosage b. Gradual increase in the daily glycoside dosage c. Inability to begin thyroid replacement therapy because of the underlying heart condition d. Increased thyroid replacement dosage

b. Gradual increase in the daily glycoside dosage If thyroid replacement therapy is started while receiving digoxin, a gradual increase in the glycoside will also be necessary to maintain adequate therapeutic activity. Decreasing the digoxin would put the patient at risk for cardiovascular complications. The two treatments can be coordinated. The thyroid medication does not need to be increased.

What is characteristic of antithyroid drugs that act on the thyroid gland? (Select all that apply.) a. They are a physiologic hormone replacement. b. They block synthesis of T3 and T4 in the thyroid gland. c. They destroy T3 and T4. d. Immediate improvement is observed. e. They may be used before subtotal thyroidectomy.

b. They block synthesis of T3 and T4 in the thyroid gland. e. They may be used before subtotal thyroidectomy. Antithyroid drugs act by blocking the synthesis of T3 and T4. They are prescribed long term for patients with hyperthyroidism and may be used for short-term treatment before subtotal thyroidectomy. Antithyroid drugs are not related to synthetic or physiologic hormone replacement. Antithyroid drugs act by blocking the synthesis of, not destroying, T3 and T4. There is a latency period of a few days to 3 weeks before symptoms improve.

A patient recently completed radiation treatment for throat cancer and presents to the healthcare provider's office with symptoms indicating possible hypothyroidism. Which symptom(s) would most likely be exhibited and/or reported? (Select all that apply.) a. Inability to sleep b. Weight gain c. Lethargy d. Nervousness e. Cold intolerance

b. Weight gain c. Lethargy e. Cold intolerance Symptoms associated with hypothyroidism include weight gain, lethargy, and cold intolerance. Inability to sleep and nervousness are not symptoms associated with hypothyroidism.

Which patient would be a candidate for radioactive iodine therapy? a. A 17-year-old woman with Graves' disease b. A 64-year-old woman with hypothyroidism c. A 46-year-old man with heart disease and thyroid cancer d. An 82-year-old man with myxedema crisis

c. A 46-year-old man with heart disease and thyroid cancer Patients typically treated with radioactive iodine therapy are those who are beyond childbearing years, those with severe complicating diseases (e.g., heart disease), those with recurrent hyperthyroidism after previous thyroid surgery, those who are poor surgical risks, and those who have unusually small thyroid glands. Women of childbearing age should not be treated with radioactive iodine. Hypothyroidism and myxedema are not treated with radioactive iodine.

The nurse is providing instruction to a patient recently prescribed a radioactive iodine isotope. Which is the correct action of this medication? a. Stimulates the synthesis of T3 and T4 hormones. b. Increases the storage of thyroxine before thyroid surgery. c. Destroys hyperactive thyroid tissue. d. Replaces deficient thyroid hormone.

c. Destroys hyperactive thyroid tissue. The thyroid gland absorbs high concentrations of radioactive iodine, which destroys the hyperactive thyroid tissue with essentially no damage to other tissues in the body. Radioactive iodine does not stimulate hormone synthesis, increase hormone storage, or replace deficient hormones.

Which nursing diagnosis may be identified for a patient with hyperthyroidism? a. Imbalanced nutrition: more than body requirements b. Constipation c. Disturbed sleep pattern d. Ineffective airway clearance

c. Disturbed sleep pattern Hyperthyroidism is caused by an excess amount of thyroid hormones. Patients typically exhibit the following symptoms: rapid, bounding pulse (even during sleep); cardiac enlargement; palpitations; and dysrhythmias. Patients are nervous and easily agitated. Reflexes are hyperactive and the patient typically experiences insomnia. A nursing diagnosis of "disturbed sleep pattern" would be a common problem. The patient with hyperthyroidism is likely to consume less than body requirements and is not likely to be constipated as a result of the disease. Ineffective airway clearance is not a common problem of patients with hyperthyroidism.

Which medication is used to treat hyperthyroidism? a. Levothyroxine (Synthroid) b. Liotrix (Thyrolar) c. Propylthiouracil (Propacil) d. Liothyronine (Cytomel)

c. Propylthiouracil (Propacil) Propylthiouracil is an antithyroid agent used in the treatment of hyperthyroidism. Levothyroxine, liotrix, and liothyronine are used to treat hypothyroidism.

The nurse transcribes a new order for liothyronine for a patient diagnosed with hypothyroidism. When educating the patient about this medication, the nurse will include that: a. the onset of action is slower than that of levothyroxine. b. it is safe for patients with cardiovascular disease to take. c. adverse effects may occur up to 3 weeks after changes in therapy have been initiated. d. symptoms of adverse effects include tachycardia and weight gain.

c. adverse effects may occur up to 3 weeks after changes in therapy have been initiated. Adverse effects may occur 1 to 3 weeks after changes in therapy have been initiated. Onset of action is more rapid than that of levothyroxine. It is not recommended for patients with cardiovascular disease. Symptoms of adverse effects include bradycardia and weight loss.

Medications ordered on a patient with hypothyroidism include liotrix and cholestyramine. The nurse administers the dose of liotrix at 08:00. When is the best time for the nurse to administer the cholestyramine? a. 07:00 b. 08:00 c. 10:00 d. 12:00

d. 12:00 To prevent binding of thyroid hormones by cholestyramine, administer doses at least 4 hours apart.

What is the mechanism of action of propylthiouracil? a. Blocks reuptake of thyroid hormone in the liver. b. Destroys hormone in the thyroid gland. c. Increases synthesis of hormone in the thyroid gland. d. Blocks synthesis of hormone in the thyroid gland.

d. Blocks synthesis of hormone in the thyroid gland. Propylthiouracil and methimazole are antithyroid agents that act by blocking the synthesis of T3 and T4 in the thyroid gland. They do not destroy any T3 or T4 already produced, so there is usually a latent period of a few days to 3 weeks before symptoms improve once therapy is started. Antithyroid medications do not block reuptake of hormones, destroy hormones, or increase synthesis of hormone.

Which condition can occur if congenital hypothyroidism is not treated? a. Diabetes b. Impaired vision c. Periorbital edema d. Cretinism

d. Cretinism Cretinism is a condition resulting from congenital hypothyroidism. Diabetes is not a complication of congenital hypothyroidism. Periorbital edema and impaired vision are complications of hyperthyroidism.

Which clinical symptom(s) would the nurse observe in a patient with thyrotoxicosis? (Select all that apply.) a. Decreased metabolic rate b. Decreased heart rate c. Decreased body temperature d. Muscle tremors e. Restlessness f. Anxiety g. Sweating

d. Muscle tremors e. Restlessness f. Anxiety g. Sweating Thyrotoxicosis symptoms include muscle weakness and tremors, restlessness and nervousness, anxiety, sweating, increased metabolic rate, increased pulse rate (to perhaps 140 beats/min), and increased body temperature and a sensation of feeling too warm.