★Words and Expressions ★
levothyroxine – n. 左甲状腺素
in terms of – 依据，就…而言
heat intolerance – 热耐受不良
ramp (up) – v. 用后脚直立，横冲直撞
propylthiouracil (PTU) – n. 丙硫氧嘧啶
graves’ disease – n. 格雷夫斯病
thyroidectomy – n. 甲状腺切除（术）
shrink – v. 萎缩，收缩
agranulocytosis – n. 粒细胞缺乏症
hepatotoxicity – n. 肝毒性
radiation sickness – 放射病
utensils – n. 器皿
Lugol’s solution – n. 复方碘溶液，卢戈氏溶液
iodism – n. 碘中毒
iodized salt – 碘化盐
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★Video ★
Thyroid Medications
★ Transcript ★
Thyroid Medications
Okay, in this video we're going to talk about medications to use for thyroid disorders. So let's first talk about a key medication used for hypothyroidism, which is when your thyroid is too low. The one to know here is levothyroxine. So levothyroxine basically acts like a synthetic form of T3 or T4, which are naturally occurring thyroid hormones in your body.
So in terms of side effects, if we give a patient too much levothyroxine, then this can cause symptoms of hyperthyroidism, like if we do our job too well, right? So symptoms of hyperthyroidism include anxiety, GI upset, sweating, weight loss, and heat intolerance. Those are really important symptoms to know. So again, everything’s kind of ramped up and you’re hot and you’re sweaty and you can't sleep and maybe you’re losing weight that type of thing.
In terms of key points while the patient is on therapy, you’re gonna want to closely monitor their T4 and TSH levels. OK? And then you want to advise your patient to take this medication on an empty stomach with a full glass of water before breakfast. And at the hospital we give thyroid medications at six a.m. So before they get up and look like an hour and a half before breakfast trays even hit the floor. So we wake everybody up at 6 a.m. with the full glass of water and they’re levothyroxine. So that is definitely an important thing to know as far as administration guidelines. For this medication, another really important thing to know is that this requires life-long treatment. So if a patient has hypothyroidism, then that’s often caused by autoimmune disorder and they will require life-long treatment with levothyroxine and so it's not like they’re gonna be able to take it for a little while and then stop taking it like any antibiotic. It will require life-long treatment.
OK so. Let’s talk about, there are actually three medications I want to cover that can be used for hyperthyroidism. So if your thyroid’s too high, these medications can bring it down. So the first one I want to talk about is propylthiouracil, which is PTU. And you would use this for graves’ disease and in preparation for a thyroidectomy. So graves’ disease is cause of severe hyperthyroidism and then if we get ready to take our thyroid out via a thyroidectomy, we want to kind of shrink it and get ready for that surgery. So you can use PTU for that.
Side effects, there's actually quite a few. So one is a granulocyte ptosis, which I've mentioned in a number of previous video causes your new account to go low, so your white blood cell count is low and you are more prone to infection. It can also cause GI upset, rash, possible hepatotoxicity. And then if the dose is too high, the patient can end up with signs of hypothyroidism. So if we do our job to well, they can end up with symptoms such as lethargy, weight gain, cold intolerance, bradycardia, and depression. Everything gets lower.
OK. Key point. It takes about one to two weeks to, for the full effects to take place for this medication and then it's important to monitor the patient’s CDC levels because of that risk of agranulocytosis. And also their liver function because of the risk of hepatotoxicity. So if you look at the drug name propylthiouracil and PTU, you can see where the PTU comes from by looking at that long drug name. I think about PTU being, prevents thyroid from being up too high. So that's how I remember TPU.
OK, then the second medication that can be used to help bring thyroid levels down is radioactive iodine. So you would use this for both hyperthyroidism as well as thyroid cancer. The mode of action is that this radioactive iodine is absorbed by the thyroid and it destroys thyroid producing cell.
Side effects include radiation sickness, bone marrow suppression, and possible hypothyroidism . So key point, you want your patient while they are taking this to increase their fluid intake and void frequently, they should limit the contact with others, so they need to maintain a safe distance from other people. Flush twice. They shouldn't share utensils for whatever that prescribed amount of tightness from the provider.
So that is radioactive iodine.
OK, the last medication in this class that I want to go over is a strong iodine solution or Lugol’s solution. So you use it for hyperthyroidism and you could also use it in preparation for a thyroidectomy. The mode of action is that it inhibits thyroid production and release due to high levels of iodine. Side effects can include GI upset and then the really important side effect to know what this medication is iodism. So symptoms of iodism include metallic taste, stomatitis, and sore throat and gums. Also another side effect includes hypersensitivity which can result in like a rash or pruritus which is like itching in the patient.
Key points. The patient should increase their fluid intake and they could mix this medication with juice to help improve the taste and they should avoid foods that are high in iodine. So this includes iodized salt as well as seafood. So that’s it for thyroid medications. When we come back we will finish up with the rest of the endocrine system medications.
Take care.
★Test ★
1. The nurse is discussing levothyroxine with a client diagnosed with hypothyroidism. Which intervention should be included in the client teaching?
A. Discuss the importance of not using iodized salt.
B. Explain the importance of not taking medication with grapefruit juice.
C. Instruct the client to take the medication in the morning.
D. Teach the client to monitor daily glucose levels. 2. The client diagnosed with hyperthyroidism is prescribed propylthiouracil (PTU). Which statement by the client warrants immediate intervention by the nurse?
A. "I seem to be drowsy and sleepy all the time."
B. "I have a sore throat and have had a fever."
C. "I have gained 2 pounds since I started taking PTU."
D. "Since taking PTU I am not as hot as I used to be."
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答案 Answer
1. C. Instruct the client to take the medication in the morning. Rationale: The medication should be taken in the morning to decrease the incidence of drug-related insomnia. 2. B. "I have a sore throat and have had a fever." Rationale: Propylthiouracil (PTU) is a hyperthyroid treatment. The antithyroid medication may affect the body's ability to defend itself against bacteria and viruses; therefore, the nurse should intervene if the client has any type of sore throat, fever, chills, malaise, or weakness.
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