NR565 Final Study Guide
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Practice and Preparation for Chamberlrain University Students, United states
Week 5
• Thyroid
o Diagnosis & Evaluation
▪ What labs are used to diagnose?
• TSH, total T4, T3, and free T4, also get LFTs and CBC
▪ Timeframe for re-check of labs after starting levothyroxine
• 6-8 weeks after starting therapy, euthyroid 1 year
▪ Signs and symptoms of hypo and hyperthyroidism
• Hyperthyroidism
o Strong & Rapid Heartbeat, Dysrhythmias, possible Angina
o Nervousness, insomnia, rapid thought flow and speech
o Skeletal muscle may weaken and atrophy
o Skin warm and moist, intolerant to heat
o Increased appetite but patient experiences weight loss
o All symptoms are called thyrotoxicosis
o If the patient has Graves’ Disease-Exophthalmos
• Hypothyroidism
o Face: Pale, Puffy, Expressionless
o Skin: Cold and Dry
o Brittle and hair loss
o Heart rate and temp are lowered
o c/o Lethargy, Fatigue, intolerance to cold
o Weight gain
o Impaired mentation
o Thyroid enlargement if decreased levels of T3 and T4
promote excessive release of TSH
o Treatment
▪ Treatment of thyroid storm
• PTU (Propylthiouracil) is the preferred treatment for thyroid
storm. High dose potassium iodine or strong iodine solution to
suppress
thyroid hormone release, or methimazole to suppress thyroid
hormone synthesis, corticosteroids, beta-blockers- reduce heart
rate, and supportive measures are needed (sedation, cooling, IV
fluids).
▪ Result of not treating hypothyroidism during pregnancy
• Permanent neurological defects, decreased IQ, large protruding
tongue, potbelly dwarfish stature, impaired development of
nervous system bone teeth and muscles.
, NR565 Final Study Guide
▪ Medication to treat symptoms of hyperthyroidism (notice this is treating
symptoms and not the hyperthyroidism itself)
• Metoprolol can be used to treat tachycardia experienced with
hyperthyroidism. Allopurinol is used in the management of gout.
Methylphenidate is a central nervous system stimulant.
▪ Drug/Food/Supplement interactions with levothyroxine
• Absorption is reduced by:
o Histamine 2 receptor blockers (Cimetidine)
o PPI (Lansoprazole, Omeprazole)
o Sucralfate (Carafate)
o Cholestyramine (Questran)
o Colestipol (Colestid)
o Aluminum containing antacids (Maalox, Mylanta)
o Iron Supplements
o Calcium supplements (Tums)
o Magnesium Salts
o Orlistat (Xenical)
o 4 Hrs between levothyroxine and the above meds is
recommended and food reduces absorption as well.
• Metabolism accelerated by:
o Phenytoin (Dilantin)
o Carbamazepine (Tegratol, Caratrol)
o Rifampin
o Sertraline
o Phenobarbital
o Patient taking these medications will need to have dose of
levothyroxine increased
• Warfarin
o Levothyroxine accelerates degradation of vitamin K
dependent clotting factors
o May need to reduce the dose of warfarin
• Catecholamines
o Increased cardiac responsiveness-at an increased risk of
catecholamine (norepinephrine, epinephrine, dopamine)-
induced dysrhythmias
• Digoxin and Insulin
o May need to have increased dosages of these if patient is
taking levothyroxine
• Diabetes
o How to confirm a diagnosis prior to beginning treatment
▪ Hemoglobin A1C > 6.5%
▪ Fasting Plasma Glucose > 126 mg/dl
▪ Random Plasma Glucose > 200 mg/dl plus symptoms of diabetes
▪ Oral glucose tolerance test (OGTT): 2-h plasma glucose > 200 mg/dL
o A1C
Be familiar with the interactive activities throughout course modules. You could see
variations of those same questions on your exams.
Practice and Preparation for Chamberlrain University Students, United states
Week 5
• Thyroid
o Diagnosis & Evaluation
▪ What labs are used to diagnose?
• TSH, total T4, T3, and free T4, also get LFTs and CBC
▪ Timeframe for re-check of labs after starting levothyroxine
• 6-8 weeks after starting therapy, euthyroid 1 year
▪ Signs and symptoms of hypo and hyperthyroidism
• Hyperthyroidism
o Strong & Rapid Heartbeat, Dysrhythmias, possible Angina
o Nervousness, insomnia, rapid thought flow and speech
o Skeletal muscle may weaken and atrophy
o Skin warm and moist, intolerant to heat
o Increased appetite but patient experiences weight loss
o All symptoms are called thyrotoxicosis
o If the patient has Graves’ Disease-Exophthalmos
• Hypothyroidism
o Face: Pale, Puffy, Expressionless
o Skin: Cold and Dry
o Brittle and hair loss
o Heart rate and temp are lowered
o c/o Lethargy, Fatigue, intolerance to cold
o Weight gain
o Impaired mentation
o Thyroid enlargement if decreased levels of T3 and T4
promote excessive release of TSH
o Treatment
▪ Treatment of thyroid storm
• PTU (Propylthiouracil) is the preferred treatment for thyroid
storm. High dose potassium iodine or strong iodine solution to
suppress
thyroid hormone release, or methimazole to suppress thyroid
hormone synthesis, corticosteroids, beta-blockers- reduce heart
rate, and supportive measures are needed (sedation, cooling, IV
fluids).
▪ Result of not treating hypothyroidism during pregnancy
• Permanent neurological defects, decreased IQ, large protruding
tongue, potbelly dwarfish stature, impaired development of
nervous system bone teeth and muscles.
, NR565 Final Study Guide
▪ Medication to treat symptoms of hyperthyroidism (notice this is treating
symptoms and not the hyperthyroidism itself)
• Metoprolol can be used to treat tachycardia experienced with
hyperthyroidism. Allopurinol is used in the management of gout.
Methylphenidate is a central nervous system stimulant.
▪ Drug/Food/Supplement interactions with levothyroxine
• Absorption is reduced by:
o Histamine 2 receptor blockers (Cimetidine)
o PPI (Lansoprazole, Omeprazole)
o Sucralfate (Carafate)
o Cholestyramine (Questran)
o Colestipol (Colestid)
o Aluminum containing antacids (Maalox, Mylanta)
o Iron Supplements
o Calcium supplements (Tums)
o Magnesium Salts
o Orlistat (Xenical)
o 4 Hrs between levothyroxine and the above meds is
recommended and food reduces absorption as well.
• Metabolism accelerated by:
o Phenytoin (Dilantin)
o Carbamazepine (Tegratol, Caratrol)
o Rifampin
o Sertraline
o Phenobarbital
o Patient taking these medications will need to have dose of
levothyroxine increased
• Warfarin
o Levothyroxine accelerates degradation of vitamin K
dependent clotting factors
o May need to reduce the dose of warfarin
• Catecholamines
o Increased cardiac responsiveness-at an increased risk of
catecholamine (norepinephrine, epinephrine, dopamine)-
induced dysrhythmias
• Digoxin and Insulin
o May need to have increased dosages of these if patient is
taking levothyroxine
• Diabetes
o How to confirm a diagnosis prior to beginning treatment
▪ Hemoglobin A1C > 6.5%
▪ Fasting Plasma Glucose > 126 mg/dl
▪ Random Plasma Glucose > 200 mg/dl plus symptoms of diabetes
▪ Oral glucose tolerance test (OGTT): 2-h plasma glucose > 200 mg/dL
o A1C
