NR 565 Final Study Guide Exam Question (Latest
):
1. WEEK 5: ... LI LI
2. Thyroid
o Diagnosis & Evaluation LI LI
What labs are used to diagnose?: -TSH - used primarily for screening and diag-
LI LI LI LI LI LI LI LI LI LI LI LI LI
nosing hypothyroid and for monitoring replacement therapy in hypothyroid patients
LI LI LI LI LI LI LI LI LI LI
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for thyroid
LI LI LI LI LI LI LI LI LI LI LI LI LI
dysfunction
LI
-T3 - Useful in the diagnosis of hyperthyroidism; can also be used to monitor hormone
LI LI LI LI LI LI LI LI LI LI LI LI LI LI
replacement therapy
LI LI
-TSH low LI
-T4 normal
LI
-T3 is high = hyperthyroidism
LI LI LI LI
3. Thyroid
o Diagnosis & Evaluation LI LI
Timeframe for re-check of labs after starting levothyroxine?: Recheck TSH 6-8
LI LI LI LI LI LI LI LI LI LI
weeks after initiating therapy and after any dosage change; Check TSH at least once a
LI LI LI LI LI LI LI LI LI LI LI LI LI LI LI
year after serum TSH is stabilized
LI LI LI LI LI LI
4. Thyroid
o Diagnosis & Evaluation LI LI
Signs and symptoms of hypothyroidism?: Hypothyroidism: Depend on severity.
LI LI LI LI LI LI LI LI
o Mild: subtle and may go unrecognized
LI LI LI LI LI
o Moderate to severe: LI LI
-Face is pale, puffy, and expressionless.
LI LI LI LI LI
LI LI
,-Skin cold and dry.
LI LI LI
-Hair is brittle and hair loss occurs.
LI LI LI LI LI LI
-Slowed Heart rate. LI LI
-Patient may complain of lethargy, fatigue, and
LI LI LI LI LI LI
-Temperature is lowered & intolerant to cold.
LI LI LI LI LI LI
-Thyroid Enlargement may occur if reduced levels of T3 and
LI LI LI LI LI LI LI LI LI
T4
LI
Mentation may be impaired.LI LI LI
5. Thyroid
o Diagnosis & Evaluation LI LI
LI LI
, Signs and symptoms of hyperthyroidism?: o Elevated Heart rate and strong, and
LI LI LI LI LI LI LI LI LI LI LI
dysrhythmias and angina may develop
LI LI LI LI LI
o The CNS is stimulated, resulting is nervousness, insomnia, rapid thought flow, and
LI LI LI LI LI LI LI LI LI LI LI
rapid speech, hyperreflexia, tremors
LI LI LI LI
o Skeletal muscles may weaken and atrophy LI LI LI LI LI
o Metabolic rate is raised, resulting in health and skin that is warm and moist LI LI LI LI LI LI LI LI LI LI LI LI LI
o Feeling Hot + Heat intolerance LI LI LI LI
o Appetit is increased but fails to match metabolic rate resulting in weight loss
LI LI LI LI LI LI LI LI LI LI LI LI
o All of these signs are referred to as thyrotoxicosis
LI LI LI LI LI LI LI LI
o Also usually present with exophthalmos - bulging of the eyes
LI LI LI LI LI LI LI LI LI
6. Thyroid
o Treatment
Treatment of thyroid storm?: Characterized by profound hyperthermia (105 de- LI LI LI LI LI LI LI LI LI
grees F or higher), severe tachycardia, restlessness, agitation, and tremor.
LI LI LI LI LI LI LI LI LI LI
Unconsciousness, coma, hypotension, and heart failure may ensure. LI LI LI LI LI LI LI
These symptoms are produced by excessive levels of thyroid hormone
LI LI LI LI LI LI LI LI LI LI
Thyroid crisis can be life threatening and requires immediate treatment.
LI LI LI LI LI LI LI LI LI LI
o High doses of potassium iodide or strong iodine solution are given to suppress
LI LI LI LI LI LI LI LI LI LI LI LI
thyroid hormone release.
LI LI LI
o Methimazole is given to suppress thyroid hormone synthesis LI LI LI LI LI LI LI
o A beta blocker is given to reduce heart rate
LI LI LI LI LI LI LI LI
o Additional measures include sedation, cooling, and giving LI LI LI LI LI LI
glucocorticoids and IVF
LI LI LI
7. Thyroid
o Treatment
Result of not treating hypothyroidism during pregnancy?: Can result in perma- nen
LI LI LI LI LI LI LI LI LI LI LI
neuropsychological deficits in the child - decrease child's IQ
LI LI LI LI LI LI LI LI LI
The effect of hypothyroidism is limited largely to the first trimester, a time during which
LI LI LI LI LI LI LI LI LI LI LI LI LI LI
the fetus is unable to produce thyroid hormone of its own
LI LI LI LI LI LI LI LI LI LI LI
Some authorities currently recommend routine screening for hypothyroidism as
LI LI LI LI LI LI LI LI
soon as pregnancy is confirmed
LI LI LI LI LI
Women already taking thyroid hormone replacement will need to increase dose by
LI LI LI LI LI LI LI LI LI LI LI
50% max between weeks 4-8 of gestation and the levels will level out by week 16
LI LI LI LI LI LI LI LI LI LI LI LI LI LI LI LI
8. Thyroid
o Treatment
LI LI
):
1. WEEK 5: ... LI LI
2. Thyroid
o Diagnosis & Evaluation LI LI
What labs are used to diagnose?: -TSH - used primarily for screening and diag-
LI LI LI LI LI LI LI LI LI LI LI LI LI
nosing hypothyroid and for monitoring replacement therapy in hypothyroid patients
LI LI LI LI LI LI LI LI LI LI
-T4 - Used to monitor thyroid hormone replacement therapy and to screen for thyroid
LI LI LI LI LI LI LI LI LI LI LI LI LI
dysfunction
LI
-T3 - Useful in the diagnosis of hyperthyroidism; can also be used to monitor hormone
LI LI LI LI LI LI LI LI LI LI LI LI LI LI
replacement therapy
LI LI
-TSH low LI
-T4 normal
LI
-T3 is high = hyperthyroidism
LI LI LI LI
3. Thyroid
o Diagnosis & Evaluation LI LI
Timeframe for re-check of labs after starting levothyroxine?: Recheck TSH 6-8
LI LI LI LI LI LI LI LI LI LI
weeks after initiating therapy and after any dosage change; Check TSH at least once a
LI LI LI LI LI LI LI LI LI LI LI LI LI LI LI
year after serum TSH is stabilized
LI LI LI LI LI LI
4. Thyroid
o Diagnosis & Evaluation LI LI
Signs and symptoms of hypothyroidism?: Hypothyroidism: Depend on severity.
LI LI LI LI LI LI LI LI
o Mild: subtle and may go unrecognized
LI LI LI LI LI
o Moderate to severe: LI LI
-Face is pale, puffy, and expressionless.
LI LI LI LI LI
LI LI
,-Skin cold and dry.
LI LI LI
-Hair is brittle and hair loss occurs.
LI LI LI LI LI LI
-Slowed Heart rate. LI LI
-Patient may complain of lethargy, fatigue, and
LI LI LI LI LI LI
-Temperature is lowered & intolerant to cold.
LI LI LI LI LI LI
-Thyroid Enlargement may occur if reduced levels of T3 and
LI LI LI LI LI LI LI LI LI
T4
LI
Mentation may be impaired.LI LI LI
5. Thyroid
o Diagnosis & Evaluation LI LI
LI LI
, Signs and symptoms of hyperthyroidism?: o Elevated Heart rate and strong, and
LI LI LI LI LI LI LI LI LI LI LI
dysrhythmias and angina may develop
LI LI LI LI LI
o The CNS is stimulated, resulting is nervousness, insomnia, rapid thought flow, and
LI LI LI LI LI LI LI LI LI LI LI
rapid speech, hyperreflexia, tremors
LI LI LI LI
o Skeletal muscles may weaken and atrophy LI LI LI LI LI
o Metabolic rate is raised, resulting in health and skin that is warm and moist LI LI LI LI LI LI LI LI LI LI LI LI LI
o Feeling Hot + Heat intolerance LI LI LI LI
o Appetit is increased but fails to match metabolic rate resulting in weight loss
LI LI LI LI LI LI LI LI LI LI LI LI
o All of these signs are referred to as thyrotoxicosis
LI LI LI LI LI LI LI LI
o Also usually present with exophthalmos - bulging of the eyes
LI LI LI LI LI LI LI LI LI
6. Thyroid
o Treatment
Treatment of thyroid storm?: Characterized by profound hyperthermia (105 de- LI LI LI LI LI LI LI LI LI
grees F or higher), severe tachycardia, restlessness, agitation, and tremor.
LI LI LI LI LI LI LI LI LI LI
Unconsciousness, coma, hypotension, and heart failure may ensure. LI LI LI LI LI LI LI
These symptoms are produced by excessive levels of thyroid hormone
LI LI LI LI LI LI LI LI LI LI
Thyroid crisis can be life threatening and requires immediate treatment.
LI LI LI LI LI LI LI LI LI LI
o High doses of potassium iodide or strong iodine solution are given to suppress
LI LI LI LI LI LI LI LI LI LI LI LI
thyroid hormone release.
LI LI LI
o Methimazole is given to suppress thyroid hormone synthesis LI LI LI LI LI LI LI
o A beta blocker is given to reduce heart rate
LI LI LI LI LI LI LI LI
o Additional measures include sedation, cooling, and giving LI LI LI LI LI LI
glucocorticoids and IVF
LI LI LI
7. Thyroid
o Treatment
Result of not treating hypothyroidism during pregnancy?: Can result in perma- nen
LI LI LI LI LI LI LI LI LI LI LI
neuropsychological deficits in the child - decrease child's IQ
LI LI LI LI LI LI LI LI LI
The effect of hypothyroidism is limited largely to the first trimester, a time during which
LI LI LI LI LI LI LI LI LI LI LI LI LI LI
the fetus is unable to produce thyroid hormone of its own
LI LI LI LI LI LI LI LI LI LI LI
Some authorities currently recommend routine screening for hypothyroidism as
LI LI LI LI LI LI LI LI
soon as pregnancy is confirmed
LI LI LI LI LI
Women already taking thyroid hormone replacement will need to increase dose by
LI LI LI LI LI LI LI LI LI LI LI
50% max between weeks 4-8 of gestation and the levels will level out by week 16
LI LI LI LI LI LI LI LI LI LI LI LI LI LI LI LI
8. Thyroid
o Treatment
LI LI
