Thyroid and Antithyroid Drugs

Every question here, with the answer

1. A client newly prescribed levothyroxine asks how to take it. Which instruction should the nurse give?

   1. Take it with breakfast and a cup of coffee.
   2. Take it at bedtime with a calcium supplement.
   3. Take it in the morning at least 30 minutes before food or caffeinated drinks.
   4. Take it only on days you feel tired.

   Answer: Take it in the morning at least 30 minutes before food or caffeinated drinks.

   Food and caffeinated drinks interfere with levothyroxine absorption, so it is taken in the morning at least 30 minutes before them. Calcium also reduces absorption, and thyroid replacement is taken every day, not as needed.

2. A client taking methimazole for hyperthyroidism calls the clinic reporting a sore throat and fever. What should the nurse recognise?

   1. These are expected effects that will pass in a few days.
   2. These are signs the client should double the next dose.
   3. These mean the dose is too low.
   4. These may be symptoms of a severe reaction and must be reported to the health care provider.

   Answer: These may be symptoms of a severe reaction and must be reported to the health care provider.

   Sore throat and fever can signal bone marrow suppression such as agranulocytosis, a severe reaction to antithyroid drugs, and must be reported. They are not expected minor effects or a sign to change the dose on one's own.

3. The nurse is reviewing the history of a client about to start a thyroid replacement drug. Which findings are contraindications? Select all that apply.

   1. Recent myocardial infarction
   2. Pituitary TSH suppression
   3. Hypothyroidism
   4. Untreated adrenal insufficiency
   5. Hyperthyroidism

   Answer: Recent myocardial infarction, Untreated adrenal insufficiency, Hyperthyroidism

   Thyroid drugs raise heart rate and contractility, overwhelm impaired adrenal glands, and would raise already elevated hormone levels in hyperthyroidism. Hypothyroidism and pituitary TSH suppression are indications, not contraindications.

4. A client asks whether levothyroxine could help her lose weight. What is the nurse's best response?

   1. Yes, but only in small doses.
   2. Yes, it speeds up metabolism and is safe for weight loss.
   3. No, thyroid hormones should not be used for weight loss because they can cause serious toxicity.
   4. No, because it causes weight gain.

   Answer: No, thyroid hormones should not be used for weight loss because they can cause serious toxicity.

   The black box warning says thyroid hormones should not be used for obesity or weight loss because of serious or life-threatening toxicity. Weight loss is an adverse effect, not weight gain, and no dose makes this use safe.

5. The nurse is caring for a client receiving an antithyroid drug. Which actions are appropriate? Select all that apply.

   1. Tell the client the drug is safe during breastfeeding.
   2. Monitor the complete blood cell count and liver studies.
   3. Teach the client to report a weight gain of 3 pounds in 24 hours.
   4. Encourage extra iodized salt and shellfish in the diet.
   5. Check with the health care provider before giving it with an anticoagulant.

   Answer: Monitor the complete blood cell count and liver studies., Teach the client to report a weight gain of 3 pounds in 24 hours., Check with the health care provider before giving it with an anticoagulant.

   The nurse monitors blood counts, coagulation, liver studies and thyroid levels, checks before giving with anticoagulants, and teaches weekly weight monitoring. Dietary iodine should not be eaten without speaking with the provider, and pregnancy and breastfeeding are contraindications.

6. A client on propylthiouracil develops yellowing of the skin and dark urine. The nurse recognises this as which adverse effect?

   1. Liver toxicity
   2. Hypersensitivity rash
   3. Hypothyroidism
   4. Heat intolerance

   Answer: Liver toxicity

   Jaundice and dark urine are listed signs of liver toxicity from antithyroid drugs, and propylthiouracil can cause hepatitis and jaundice. Hypothyroidism shows as fatigue, weight gain and cold intolerance, not jaundice.