Simple Nursing Endocrine NCLEX® Review (2023)

Hyperthyroidism vs. Hypothyroidism

The thyroid gland plays key role in the endocrine system as it manages a variety of pathways was significant clinical implications. Generally, the thyroid gland and the hormones involved are associated with the regulation of metabolism. Hyperthyroidism can be attributed with an increased metabolism while the opposite is true for hypothyroidism.

The pathway originates in the hypothalamus where it secretes thyroid-releasing hormone (TRH). This triggers thyroid stimulating hormone (TSH), ultimately leading to the production of two hormones.

T4 is the first hormone produced and T3 is the second one which is also known as the active thyroid hormone. TSH also stimulates the release of calcitonin, which causes the removal of calcium from the blood into the bones. It is also important to note that iodine is a key component in thyroid hormone production.


Symptoms of Hyperthyroidism

Hyperthyroidism can be caused by several factors including excessive iodine intake via diet, Graves’ disease, and potentially thyroid replacement overdose (levothyroxine overdose). Hyperthyroidism can be attributed largely to characteristics that reflect increased metabolism suggesting increased energy.

A clinical manifestation of hyperthyroidism is called a thyroid storm, where too much thyroid hormone is released into the system. A client with thyroids storm will present with marked agitation, confusion, and restlessness.

In addition, these clients may experience increased temperature, tachycardia (HR > 100 bpm), heart palpitations, and hypertension. Physically clients suffering from hyperthyroidism may exhibit grape eyes (exophthalmos) where the eyes appear to bulge outwards. They may also develop a goiter which is an abnormal enlargement of the thyroid gland.

Other manifestations may be weight loss as the client’s metabolism becomes ramped up as well as diarrhea as the digestive tract becomes sped up.

Hyperthyroidism Nursing Interventions and Pharmacology

There are a variety of interventions that can be made on the behalf of clients experiencing hyperthyroidism. A key one to make is to eliminate the cause whether it is reducing the dose of thyroid replacement therapy or dietary iodine reduction.

As a result of increased metabolism these clients may require increased caloric intake high in proteins and carbs depending on their baseline weight. They may need to consume frequent meals and snacks up to 6-8 times per day. Due to other effects such as diarrhea in these clients, it’s advised that they avoid caffeine, high-fiber foods, and spicy foods as well.

There are several pharmacological interventions that clients with hyperthyroidism may benefit from. A commonly prescribed medication for this condition is methimazole.

Methimazole works by inhibiting the synthesis of thyroid hormone. It’s important to know that methimazole is not safe for pregnant women where other treatments may be. PTU or propylthiouracil also works to inhibit the production of thyroid hormone-like methimazole but through different mechanisms. This medication is safe for pregnancy but may cause side effects such as fever or sore throat.

Clients may be required to remove the thyroid gland which can be achieved by two different modalities. The first begins by providing clients potassium iodide which acts to shrink the thyroid gland in preparation for thyroidectomy (surgical removal of the gland).

Potassium iodide may stain the client’s teeth and should not be taken with methimazole or PTU. During the removal of the thyroid gland the hormones may dump into the client’s system which can cause a thyroid storm, so monitoring is a key intervention for these clients.

It’s also important to note that abrupt discontinuation of thyroid hormone production can cause a Myxedema coma which can be life threatening. An endotracheal tube should be at the client’s bedside to intervene in the presence of severe respiratory depression.

Calcium levels should also be monitored in the event of hypocalcemia (Ca++ < 8.6 mEq/L). Hypocalcemia may present with Chvostek’s sign, which is the twitching of facial muscles or Trousseau’s sign, carpopedal spasms which occurs after inflating a blood pressure cuff for three minutes.

Another thyroid removal method involves the destruction of the thyroid gland by administering radioactive iodine also known as radioactive iodine uptake (RAIU). RAIU destroys the thyroid gland in the same way radiation would. This should only be used in clients who are not pregnant so women should have a negative result before starting.

These clients should not be given sedatives or anesthesia and should not be wearing jewelry around the neck or dentures. They should hold antithyroid medications 5-7 days prior to the procedure to prevent acute hypothyroidism. Lastly, these clients should avoid other people (especially pregnant women) as the isotope can also damage their thyroid gland. They may even be advised to use separate restrooms and flush multiple times to prevent any further issues.

The last consideration to keep in mind for treatment of hyperthyroid clients is that their heart rate may be dangerously elevated. They can be treated with a beta blocker to reduce their heart rate. Examples of beta blockers includes atenolol, propranolol, and metoprolol. All beta blockers end with the suffix “prolol” which can aid in memorization of the various treatments.


Symptoms of Hypothyroidism

Hypothyroidism is a much more prevalent disorder which can be caused by low dietary iodine, Hashimoto’s disease, a pituitary tumor, and naturally due to the removal of the thyroid gland. Another potential cause is abrupt discontinuation of thyroid replacement therapy (e.g. levothyroxine).

Some classic signs and symptoms includes reduced energy, weight gain, slowed mental status and depression. Weight gain is due to both water retention and reduced energy output since the client’s metabolism is low. Other symptoms can include hair loss (alopecia), constipation, dry skin turgor, reduced sexual appetite and irregular and slowed menstrual cycles (amenorrhea).

Clinically these clients may exhibit bradycardia (HR < 60 bpm), reduced blood pressure, reduced temperature and cold intolerance, and a reduced respiratory rate. A key manifestation of this respiratory depression is known as a Myxedema coma where the client’s breathing becomes drastically inhibited potentially leading to death.

Hypothyroidism Nursing Interventions and Pharmacology

Clients with hypothyroidism may need to be managed according to their reduced metabolic rate. The implication is that they should reduce their caloric load as well as cholesterol and saturated fats. They should be advised to rest frequently as well as avoid CNS depressants (e.g. opioids, benzos, muscle relaxants, EtOH).

Pharmacological intervention for hypothyroidism are relatively straight forward as the hormone simply need to get replaced. The most common medication used for this condition is levothyroxine, which is simply a synthetic form of T4. Another thyroid supplement is armor thyroid which replaces both T3 and T4.

Clients on these medications should be counseled on taking it in the early morning on an empty stomach (30-60 minutes before breakfast). Levothyroxine takes several weeks (3-4 weeks) to achieve relief in clients. Clients will have to be on thyroid replacement chronically for the rest of their lives – which may take time for the physician to determine the optimal dosage. Levothyroxine and other replacement hormones should not be stopped abruptly which could lead to events like a Myxedema coma.


The parathyroid glands are mainly responsible for controlling the regulation of blood calcium. Parathyroidism is a condition that causes the parathyroid glands to produce too much or too little parathyroid hormone (PTH).

Hyperparathyroidism Pathophysiology

Hyperparathyroidism is a result of the increased production of PTH. PTH makes bones weak by taking calcium from its storage. This also results in high calcium, also known as hypercalcemia (over 10.5).

Hypoparathyroidism Pathophysiology

Hypoparathyroidism is a result of decreased production or resistance to PTH. This also results in low calcium, also known as hypocalcemia (under 9.0)

Signs include:

  • Trousseau’s Sign:
    • T – Twerk with BP cuff
  • Chvostek’s Sign
    • C – Cheeky smile when stroking the face
  • 3. Diarrhea

Hyperparathyroidism Causes

  • Tumor
    • • Adenoma – NOT cancerous
    • • Malignant – Cancerous
  • Vitamin D deficiency (since it helps Ca absorb)
  • GI issues = Malabsorption of calcium
  • Renal failure

Hypoparathyroidism Causes

  • Thyroidectomy
  • Low Mag+ (Hypomagnesemia)
  • Autoimmune – body attacks the parathyroids
  • Radiation Treatment – damages the thyroid

Hyperparathyroidism Treatment

  • Lower the high blood calcium
    • IV furosemide & saline to flush out Ca
    • IV phosphate to lower Ca
  • Parathyroidectomy – cut the tumor out

Hypoparathyroidism Treatment

  • Increase the low blood calcium
    • IV Calcium gluconate
    • Vitamin D (helps the absorption of Ca)
  • Seizure precautions and phenobarbital to decrease neuronal excitability

Endocrine System Conclusion

The endocrine system is a complex web of pathways that has been the target of numerous interventions over the last few decades. There are many debilitating diseases that can affect clients ranging from steroid production to metabolic efficiency. The physical and clinical manifestations of these disorders are numerous yet often easy to distinguish. For this reason, it is imperative to understand these diseases well when preparing for the NCLEX®exam.

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