HYPOthyroid
Sign and Symptoms
Develop slowly overtime..
Fatigue, weight gain, depression, brittle hair & nails, cold intolerance
Signs and Symptoms
Diarrhea/frequent bowel movements, increased appetite, muscle
weakness, heat intolerance, exophthalmos, sleep disorders,
palpitations, tachycardia, nervous/irritable, goiter
Prednisone Side Effects
Increased blood sugar Abnormal fat deposits
• Muscle wasting Sodium & water retention
• Thin skin Glaucoma
• Psychosis / Irritability Hypertension
• Increased risk of infection
Levothyroxine (Synthroid)
• Indication: Thyroid replacement therapy for hypothyroid
• Side effects: hyperthyroid
• Interactions: decrease Digoxin effect, enhance oral anticoagulants, decrease insulin & anti-diabetic drugs
Propylthiouracil (PTU)
• Antithyroid drug / suppresses thyroid hormone production
• Used prior to surgery to remove the thyroid
• Side effects: agranulocytosis, hypothyroid, liver toxicity
Prednisone Client Education
• Take with food
• MUST taper off
• Avoid during pregnancy
Levothyroxine (Synthroid) Nursing Considerations
• Take daily, lifelong treatment
• 3-4 weeks for therapeutic effects
• Teach signs of hyperthyroid
• Dosed in micrograms (mcg)
• Take 30-60 minutes before breakfast
• Brands cannot be interchanged
Propylthiouracil (PTU) Nursing Considerations
• Monitor for hypothyroid (fatigue, weakness, weight gain, cold intolerance, and dry skin)
• Teach to report signs of infection
*Rash is a COMMON adverse effect
Prednisone MOA
For clients who produce insufficient cortisol, the body needs cortisol to make and store glucose. cortisol production increases during periods of stress to ensure BP and BS levels are adequate
• Treat pain
• Suppress inflammation
Levothyroxine Adverse Reaction
monitor for indication of HYPERthyroidism, nervousness, tachycardia, palpitations, diaphoresis, fever, heat intolerance, weight loss
Propylthiouracil (PTU) Safety Alert
agranulocytosis is an adverse effect of PTU, client's who are immunocompromised are likely to develop this putting them at risk for infection.
Obtain a baseline CBC and monitor periodically
Prednisone Nursing Considerations
Taper the dose slowly to establish the lowest possible therapeutic dose
monitor for hypoglycemia and hypotension, fatigue
Levothyroxine Client Education
The drug will need to be taken daily for the rest of their lives
report signs and symptoms of HYPERthyroidism
Propylthiouracil (PTU) Client Education
Report fever or sore throat due to risk for agranulocytosis (severe form of neutropenia)
Prednisone Dosage
Low dose = therapeutic doses & few side effects
High dose = multiple adverse reactions