Question

Genevieve is a 45-year-old woman with three children who works part time and has recently returned to nursing school. She has sought care from her primary care provider. While taking a health history, Genevieve tells the nurse that she has noticed that she is feeling very tired, is cold all of the time, and has gained 15 pounds without a change in eating habits.

1. What other symptoms could accompany hypothyroidism?

2. Genevieve’s provider performs an assessment, noting that she has cool skin, brittle nails, coarse and dry hair, slight abdominal distension, and poor wound healing on an older cut. The provider orders laboratory work.

Which laboratory tests would assist in confirming a diagnosis of hypothyroidism?

3. Laboratory results indicate a decreased T3 and T4, and a high level of TSH. Genevieve is diagnosed with hypothyroidism, and placed on levothyroxine (Synthroid).

What priority concerns should the nurse identify?

Answer 1

1. Hypothyroidism is characterised by low levels of thyroid hormones in the blood. This results in variety of symptoms such as fatigue, weakness, joint and muscle pain, paraesthesia, weight gain, cold jntilerance, hair loss, cold and dry skin, attention and memory deficits, menstrual irregularities.
2. The doctor should order a blood test to test the levels of TSH, T4 and T3.
The normal level of TSH is 0.4 mU/L to 4.0 mU/L.

The normal level of T4 is 5.0 – 11.0 ug/dL

The normal level of T3 is 100 - 200 ng/dL

Hypothyroidism is characterised by low levels of T4 and T3 hormone despite high levels of TSH.
3. The priority nursing considerations for Levothyroxine include:

- teach the patient to take the medicine every morning empty stomach with a glass of water. Advice patient not to switch medicine brand.

- Ask the patient to take only the prescribed amount of dose.
- Regular monitoring of BP and pulse is necessary.
- Regular monitoring of thyroid panel is necessary

- avoid medications such as anticoagulant, calcium with thyroid medications as it causes undesired symptoms from drug drug interactions